Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan; Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
J Infect Chemother. 2022 Jun;28(6):745-752. doi: 10.1016/j.jiac.2022.02.012. Epub 2022 Feb 24.
Understanding risk factors for antibiotic resistance (AR) in patients with hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) is important to select appropriate initial antibiotics and reduce broad-spectrum antibiotic overuse. However, available evidence is limited. We aimed to identify risk factors for AR in those patients.
This prospective observational study was conducted at a tertiary-care hospital. Pathogens with AR were defined as those resistant to ampicillin-sulbactam or ceftriaxone. Risk factors for AR in patients with HAP and VAP were assessed using penalized logistic regression analysis.
In total, 557 patients with HAP and VAP were enrolled. Pathogens were isolated from 315 patients, with AR identified in 68.3% (215/315). Among antibiotic-resistant pathogens (ARPs), Pseudomonas aeruginosa was isolated most frequently, followed by methicillin-resistant Staphylococcus aureus (MRSA). Significant risk factors for AR were chronic renal diseases (adjusted odds ratio: 2.82, 95% confidence interval: 1.79-7.83), history of ARP infection/colonization within the past 1 year (2.80, 1.90-7.02), bedridden state (1.84, 1.28-3.91), tube feeding (1.58, 1.09-2.98), and peripheral or central venous catheterization (1.57, 1.06-2.96). Additionally, a risk factor for ARPs that should be treated with anti-MRSA antibiotics was prior MRSA infection/colonization history. Those for ARPs requiring dual antipseudomonal antibiotics included prior non-MRSA ARP or MRSA infection/colonization history and bedridden state.
The five factors we highlighted can be important criteria for identifying patients at risk of AR. Physicians should consider these potential risk factors when selecting antibiotics for initial empirical therapy in patients with HAP and VAP.
了解医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）患者中抗生素耐药（AR）的风险因素对于选择合适的初始抗生素和减少广谱抗生素的过度使用非常重要。然而，现有证据有限。我们旨在确定这些患者中 AR 的风险因素。
这是一项在三级保健医院进行的前瞻性观察性研究。对 AR 病原体的定义为对氨苄西林-舒巴坦或头孢曲松耐药的病原体。使用惩罚性逻辑回归分析评估 HAP 和 VAP 患者中 AR 的风险因素。
共纳入 557 例 HAP 和 VAP 患者。从 315 例患者中分离出病原体，其中 68.3%（215/315）存在 AR。在抗生素耐药病原体（ARPs）中，分离出最常见的病原体是铜绿假单胞菌，其次是耐甲氧西林金黄色葡萄球菌（MRSA）。AR 的显著危险因素是慢性肾脏疾病（调整后的优势比：2.82，95%置信区间：1.79-7.83）、过去 1 年内有 ARP 感染/定植史（2.80，1.90-7.02）、卧床状态（1.84，1.28-3.91）、管饲（1.58，1.09-2.98）和外周或中心静脉置管（1.57，1.06-2.96）。此外，需要用抗-MRSA 抗生素治疗的 ARPs 的危险因素是既往 MRSA 感染/定植史。需要使用双联抗假单胞菌抗生素的 ARPs 的危险因素包括既往非-MRSA ARP 或 MRSA 感染/定植史和卧床状态。
我们强调的五个因素可能是识别 AR 风险患者的重要标准。医生在为 HAP 和 VAP 患者选择初始经验性治疗抗生素时，应考虑这些潜在的风险因素。
