CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France.
CH Vannes, Service de Réanimation Polyvalente, Vannes, France.
Clin Microbiol Infect. 2023 Jan;29(1):108.e7-108.e13. doi: 10.1016/j.cmi.2022.07.027. Epub 2022 Aug 6.
Pneumonia is the most frequent infectious complication in patients who have experienced drowning that requires intensive care unit (ICU) admission. We aimed to describe clinical, microbiological, and therapeutic data as well as predictors and impacts of such pneumonia on patients' outcomes.
We conducted a retrospective, multicentre study (2013-2020) of 270 consecutive patients admitted for drowning to 14 ICUs in Western France. Their baseline characteristics and outcomes were compared according to the occurrence of drowning-associated pneumonia (DAP), defined as pneumonia diagnosed within 48 hours of ICU admission. A Cox regression model was used to compare survival on day 28, and logistic regression was used to identify risk factors for DAP. Microbiological characteristics and empirical antibacterial treatment were also analysed.
Among the 270 patients admitted to the ICU for drowning, 101 (37.4%) and 33 (12.2%) experienced pneumonia and microbiologically proven DAP, respectively. The occurrence of pneumonia was associated with higher severity scores at ICU admission (median Simplified Acute Physiology Score II, 34 [interquartile range {IQR}, 25-55] vs. 45 [IQR, 28-67]; p 0.006) and longer ICU length of stay (2 days [IQR, 1-3] vs. 4 days [IQR, 2-7]; p < 0.001). The 28-day mortality rate was higher among these patients (29/101 [28.7%] vs. 26/169 [15.4%]; p 0.013). Microbiologically proven DAP remained associated with higher 28-day mortality after adjustments for cardiac arrest and water salinity (adjusted hazard ratio, 1.86 [95% CI, 1.06-3.28]; p 0.03). A microbiological analysis of respiratory samples showed a high proportion of gram-negative bacilli (23/56; 41.1%), with a high prevalence of amoxicillin-clavulanate resistance (12/33; 36.4%).
Pneumonia is a common complication in patients admitted in the ICU for drowning and is associated with increased mortality.
肺炎是经历溺水后需要入住重症监护病房（ICU）的患者最常见的感染性并发症。我们旨在描述临床、微生物学和治疗数据，以及此类肺炎对患者预后的预测因素和影响。
我们进行了一项回顾性、多中心研究（2013-2020 年），纳入了 270 例连续入住法国西部 14 个 ICU 的溺水患者。根据是否发生溺水相关肺炎（DAP）对其基线特征和结局进行比较，DAP 定义为在 ICU 入住后 48 小时内诊断的肺炎。使用 Cox 回归模型比较第 28 天的生存率，使用逻辑回归分析确定 DAP 的风险因素。还分析了微生物学特征和经验性抗菌治疗。
在 270 例因溺水而入住 ICU 的患者中，101 例（37.4%）和 33 例（12.2%）发生肺炎和微生物学证实的 DAP。肺炎的发生与 ICU 入住时更高的严重程度评分相关（中位数简化急性生理学评分 II，34 [四分位距 {IQR}，25-55] 比 45 [IQR，28-67]；p 0.006）和更长的 ICU 住院时间（2 天 [IQR，1-3] 比 4 天 [IQR，2-7]；p<0.001）。这些患者的 28 天死亡率更高（29/101 [28.7%] 比 26/169 [15.4%]；p 0.013）。在调整心脏骤停和水盐度后，微生物学证实的 DAP 与更高的 28 天死亡率仍相关（调整后的危险比，1.86 [95%CI，1.06-3.28]；p 0.03）。对呼吸样本的微生物分析显示，革兰氏阴性杆菌的比例很高（23/56；41.1%），阿莫西林-克拉维酸耐药率很高（12/33；36.4%）。
肺炎是入住 ICU 的溺水患者的常见并发症，与死亡率增加相关。
