成人心脏手术后多重耐药菌引起呼吸机相关性肺炎的危险因素。
Risk factors for ventilator-associated pneumonia due to multi-drug resistant organisms after cardiac surgery in adults.
机构信息
Department of Disease Control and Prevention, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, 710032, Xi'an, China.
出版信息
BMC Cardiovasc Disord. 2022 Nov 4;22(1):465. doi: 10.1186/s12872-022-02890-5.
BACKGROUND
Ventilator-associated pneumonia (VAP) is one of the most common intensive care unit (ICU)-acquired infections, which can cause multiple adverse events. Due to bacterial mutation and overuse of antimicrobial drugs, multidrug-resistant organisms (MDRO) has become one of the major causes of postoperative VAP infections in cardiac patients. Therefore, this study aims to explore the risk factors for VAP with MDRO following cardiac surgery in adults.
METHODS
The clinical data of adult VAP patients following cardiac surgery in the hospital from Jan 2017 to May 2021 were analyzed retrospectively, and the patients were divided into the MDRO VAP group and the non-MDRO VAP group. Univariable and multivariable logistic regression analyses were performed on risk factors in patients with MDRO VAP. The species and drug sensitivity of pathogens isolated from the VAP patients were also analyzed.
RESULTS
A total of 61 VAP cases were involved in this study, with 34 cases in the MDRO VAP group (55.7%) and 27 cases in the non-MDRO VAP group (44.3%). Multivariable logistic regression analysis showed that independent risk factors for MDRO VAP included preoperative creatinine clearance rate (CCR) ≥ 86.6ml, intraoperative cardiopulmonary bypass (CPB) time ≥ 151 min, postoperative acute kidney injury (AKI) and nasal feeding. Gram-negative bacilli were the main pathogens in VAP patients (n = 54, 90.0%), with the highest rate of Acinetobacter baumannii (n = 24, 40.0%). Additionally, patients with MDRO VAP had a significantly longer postoperative intensive care unit (ICU) duration and higher hospitalization costs than non-MDRO VAP patients, but there was no notable difference in the 28-day mortality rate between the two groups.
CONCLUSION
Based on implementing measures to prevent VAP, clinicians should pay more attention to patients with kidney disease, longer intraoperative CPB time, and postoperative nasal feeding to avoid MDRO infections.
背景
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）最常见的获得性感染之一，可导致多种不良事件。由于细菌突变和抗菌药物的过度使用，多重耐药菌（MDRO）已成为导致心脏手术后患者 VAP 感染的主要原因之一。因此，本研究旨在探讨成人心脏手术后并发 MDRO 的 VAP 的危险因素。
方法
回顾性分析 2017 年 1 月至 2021 年 5 月我院成人心脏手术后 VAP 患者的临床资料，根据患者是否为 MDRO 分为 MDRO VAP 组和非 MDRO VAP 组。对 MDRO VAP 患者的危险因素进行单因素和多因素 logistic 回归分析。还分析了 VAP 患者分离的病原体的种类和药敏情况。
结果
本研究共纳入 61 例 VAP 病例，其中 MDRO VAP 组 34 例（55.7%），非 MDRO VAP 组 27 例（44.3%）。多因素 logistic 回归分析显示，MDRO VAP 的独立危险因素包括术前肌酐清除率（CCR）≥86.6ml、术中体外循环（CPB）时间≥151min、术后急性肾损伤（AKI）和鼻饲。革兰氏阴性杆菌是 VAP 患者的主要病原体（n=54，90.0%），其中鲍曼不动杆菌（n=24，40.0%）的比例最高。此外，MDRO VAP 患者术后 ICU 时间和住院费用明显长于非 MDRO VAP 患者，但两组 28 天死亡率无显著差异。
结论
在实施预防 VAP 的措施基础上，临床医生应更加关注合并肾脏疾病、术中 CPB 时间较长和术后鼻饲的患者，以避免 MDRO 感染。
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