Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, No. 2, Yude Road, Taichung, 404332, Taiwan.
Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan.
Sci Rep. 2022 May 7;12(1):7501. doi: 10.1038/s41598-022-11061-7.
Nosocomial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a growing threat due to the limited therapeutic choices and high mortality rate. The aim of this study was to evaluate the prognostic factors for mortality in patients with nosocomial pneumonia caused by CRGNB and the impact of colistin-based therapy on the outcomes of intensive care unit (ICU) patients. We conducted a retrospective study of the ICUs in five tertiary teaching hospitals in Taiwan. Patients with nosocomial pneumonia caused by CRGNB from January 2016 to December 2016 were included. Prognostic factors for mortality were analyzed using multivariate logistic regression. The influence of colistin-based therapy on mortality and clinical and microbiological outcomes were evaluated in subgroups using different severity stratification criteria. A total of 690 patients were enrolled in the study, with an in-hospital mortality of 46.1%. The most common CRGNB pathogens were Acinetobacter baumannii (78.7%) and Pseudomonas aeruginosa (13.0%). Significant predictors (odds ratio and 95% confidence interval) of mortality from multivariate analysis were a length of hospital stay (LOS) prior to pneumonia of longer than 9 days (2.18, 1.53-3.10), a sequential organ failure assessment (SOFA) score of more than 7 (2.36, 1.65-3.37), supportive care with vasopressor therapy (3.21, 2.26-4.56), and escalation of antimicrobial therapy (0.71, 0.50-0.99). There were no significant differences between the colistin-based therapy in the deceased and survival groups (42.1% vs. 42.7%, p = 0.873). In the subgroup analysis, patients with multiple organ involvement (> 2 organs) or higher SOFA score (> 7) receiving colistin-based therapy had better survival outcomes. Prolonged LOS prior to pneumonia onset, high SOFA score, vasopressor requirement, and timely escalation of antimicrobial therapy were predictors for mortality in critically ill patients with nosocomial CRGNB pneumonia. Colistin-based therapy was associated with better survival outcomes in subgroups of patients with a SOFA score of more than 7 and multiple organ involvement.
医院获得性耐碳青霉烯革兰阴性菌（CRGNB）肺炎是一种日益严重的威胁，由于治疗选择有限和死亡率高。本研究旨在评估 CRGNB 引起的医院获得性肺炎患者死亡的预后因素，以及粘菌素为基础的治疗对重症监护病房（ICU）患者结局的影响。我们对台湾五所三级教学医院的 ICU 进行了回顾性研究。纳入 2016 年 1 月至 2016 年 12 月期间由 CRGNB 引起的医院获得性肺炎患者。使用多变量逻辑回归分析死亡率的预后因素。使用不同严重程度分层标准，在亚组中评估粘菌素为基础的治疗对死亡率和临床及微生物学结局的影响。共纳入 690 例患者，院内死亡率为 46.1%。最常见的 CRGNB 病原体是鲍曼不动杆菌（78.7%）和铜绿假单胞菌（13.0%）。多变量分析的显著预后因素（比值比和 95%置信区间）为肺炎前住院时间（LOS）长于 9 天（2.18，1.53-3.10）、序贯器官衰竭评估（SOFA）评分大于 7（2.36，1.65-3.37）、血管加压素治疗的支持性护理（3.21，2.26-4.56）和抗菌药物治疗的升级（0.71，0.50-0.99）。在死亡组和存活组之间，粘菌素治疗无显著差异（42.1% vs. 42.7%，p=0.873）。亚组分析显示，多器官受累（>2 个器官）或 SOFA 评分较高（>7）的患者接受粘菌素为基础的治疗，其生存结局更好。肺炎发病前 LOS 延长、SOFA 评分高、需要血管加压素和及时升级抗菌治疗是重症 CRGNB 肺炎患者死亡的预测因素。在 SOFA 评分>7 和多器官受累的亚组患者中，粘菌素为基础的治疗与更好的生存结局相关。
