Sobala Ruth, Carlin Hannah, Fretwell Thomas, Shakir Sufyan, Cattermole Katie, Royston Amy, McCallion Paul, Davison John, Lumb Joanna, Tedd Hilary, Messer Ben, De Soyza Anthony
North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK.
Freeman Hospital, Newcastle, UK.
ERJ Open Res. 2022 Apr 19;8(2). doi: 10.1183/23120541.00687-2021. eCollection 2022 Apr.
increases morbidity and mortality in respiratory disease. To date the long-term ventilation population does not have clear guidelines regarding its management.
We undertook a retrospective observational study in a regional long-term ventilation population (837 patients). We defined the primary outcome as isolation. In addition positive cultures for copathogens (, species, , complex and nontuberculous mycobacteria) were recorded Logistic regression and odds ratios were calculated.
17.6% of the cohort isolated , and this pathogen was cultured more frequently in patients with a tracheostomy (logistic regression coefficient 2.90, p≤0.0001) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48, p≤0.0001). 6.3% of patients were ventilated tracheostomy. In the positive cohort 46.9% of patients were treated with a long-term macrolide, 36.7% received a nebulised antibiotic and 21.1% received both. Tracheostomised positive patients received a nebulised antibiotic more frequently (OR 2.63, 95% CI 1.23-5.64, p=0.013). Copathogens were isolated in 33.3% of the cohort. In this cohort patients with a tracheostomy grew a copathogen more frequently than those without (OR 2.75, 95% CI 1.28-5.90).
isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Further research and international guidelines are needed to establish the prognostic impact of and to guide on antimicrobial management. The increased risk of should be considered when contemplating long-term ventilation tracheostomy.
增加呼吸系统疾病的发病率和死亡率。迄今为止，长期通气人群在管理方面尚无明确指南。
我们对一个地区的长期通气人群（837例患者）进行了一项回顾性观察研究。我们将主要结局定义为分离出[病原体名称未给出]。此外，记录了共病原体（[具体病原体未详细列出]物种、[具体病原体未详细列出]复合体和非结核分枝杆菌）的阳性培养结果。计算了逻辑回归和比值比。
该队列中17.6%的患者分离出[病原体名称未给出]，这种病原体在气管切开术患者（逻辑回归系数2.90，p≤0.0001）和囊性纤维化/支气管扩张患者（逻辑回归系数2.48，p≤0.0001）中培养更为频繁。6.3%的患者通过气管切开术进行通气。在[病原体名称未给出]阳性队列中，46.9%的患者接受了长期大环内酯类药物治疗，36.7%的患者接受了雾化抗生素治疗，21.1%的患者两者都接受了治疗。气管切开的[病原体名称未给出]阳性患者更频繁地接受雾化抗生素治疗（比值比2.63，95%置信区间1.23 - 5.64，p = 0.013）。33.3%的队列中分离出共病原体。在该队列中，气管切开的患者比未气管切开的患者更频繁地培养出共病原体（比值比2.75，95%置信区间1.28 - 5.90）。
[病原体名称未给出]分离在成年长期通气人群中很常见，并且与气管切开术、囊性纤维化和支气管扩张显著相关。需要进一步研究和国际指南来确定[病原体名称未给出]的预后影响并指导抗菌管理。在考虑气管切开术进行长期通气时，应考虑[病原体名称未给出]增加的风险。
