Service de médecine intensive réanimation, hôpital Cochin, AP-HP. CUP, Paris, France; Université de Paris, Paris, France.
Service de médecine intensive réanimation, hôpital Cochin, AP-HP. CUP, Paris, France.
J Crit Care. 2022 Oct;71:154068. doi: 10.1016/j.jcrc.2022.154068. Epub 2022 May 27.
The objective is to identify the risk markers of multi-drug resistant bacteria (MDRB) related ventilator-associated pneumonia (VAP) in septic shock patients with previous MDRB carriage.
This retrospective study was conducted in a medical ICU from 2010 to 2020. Consecutive patients with septic shock and still in the ICU after 48 h, were eligible. The following microorganisms were defined as MDRB: extended-spectrum beta-lactamase producing enterobacteriaceae, methicillin-resistant Staphylococcus aureus, multi-drug resistant Pseudomonas aeruginosa, imipenem-resistant Acinetobacter baumanii and Stenotrophomonas maltophilia. Screening for MDRB colonization was performed at ICU admission and during ICU stay. The determinants of MDRB-related VAP were assessed using a time-dependent cause-specific Cox model.
643 patients were analyzed and 122 (18.9%) had at least one episode of VAP. The overall ICU mortality was 32.5%. The incidence of MDRB carriage was 31%, distributed into MDRB carriage at admission (14.3%) and MDRB acquired during ICU stay (16.7%). In multivariate analysis, MDRB colonization in ICU was independently associated with an increased risk of VAP (CSH: 1.85; 95% CI: 1.05-3.23; p = 0.03) whereas carriage prior to admission was not.
Imported and acquired MDRB carriage harbor different risks of subsequent MDRB-related VAP in patients with septic shock.
本研究旨在确定携带多重耐药菌（MDRB）的脓毒症休克患者发生呼吸机相关性肺炎（VAP）的风险标志物。
本回顾性研究于 2010 年至 2020 年在一家医疗重症监护病房（ICU）进行。入选标准为脓毒症休克患者，且在入住 ICU 48 小时后仍在 ICU 中。MDRB 定义为产超广谱β-内酰胺酶的肠杆菌科、耐甲氧西林金黄色葡萄球菌、多重耐药铜绿假单胞菌、耐碳青霉烯类不动杆菌和嗜麦芽窄食单胞菌。在 ICU 入住时和入住期间进行 MDRB 定植筛查。使用时间依赖性特异性 Cox 模型评估 MDRB 相关 VAP 的决定因素。
共分析了 643 例患者，其中 122 例（18.9%）至少发生了一次 VAP。总体 ICU 死亡率为 32.5%。MDRB 携带率为 31%，分布为入住时 MDRB 携带（14.3%）和入住期间获得 MDRB 携带（16.7%）。多变量分析显示，ICU 内 MDRB 定植与 VAP 的发生风险增加独立相关（CSH：1.85；95%CI：1.05-3.23；p=0.03），而入院前的 MDRB 携带则与 VAP 无相关性。
在脓毒症休克患者中，携带的和获得的 MDRB 定植具有不同的随后发生 MDRB 相关 VAP 的风险。
