Adukauskiene Dalia, Ciginskiene Ausra, Adukauskaite Agne, Koulenti Despoina, Rello Jordi
Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
Department of Cardiology and Angiology, University Hospital of Innsbruck, 6020 Innsbruck, Austria.
Antibiotics (Basel). 2023 Jun 15;12(6):1056. doi: 10.3390/antibiotics12061056.
VAP due to multidrug-resistant (MDR) bacteria is a frequent infection among patients in ICUs. Patient characteristics and mortality in mono- and polybacterial cases of VAP may differ. A single-centre, retrospective 3-year study was conducted in the four ICUs of a Lithuanian referral university hospital, aiming to compare both the clinical features and the 60-day ICU all-cause mortality of monobacterial and polybacterial MDR spp. VAP episodes. Of the 86 MDR spp. VAP episodes analyzed, 50 (58.1%) were polybacterial. The 60-day mortality was higher ( < 0.05) in polybacterial episodes: overall (50.0 vs. 27.8%), in the sub-group with less-severe disease (SOFA < 8) at VAP onset (45.5 vs. 15.0%), even with appropriate treatment (41.7 vs. 12.5%), and the sub-group of extended drug-resistant (XDR) spp. (46.4 vs. 17.6%). The ICU mortality (44.0 vs. 22.5%) was also higher in the polybacterial episodes. The monobacterial MDR spp. VAP was associated ( < 0.05) with prior hospitalization (61.1 vs. 40.0%), diabetes mellitus (30.6 vs. 5.8%), obesity (30.6 vs. 4.7%), prior antibiotic therapy (77.8 vs. 52.0%), prior treatment with cephalosporins (66.7 vs. 36.0%), and SOFA cardiovascular ≥ 3 (44.4 vs. 10.0%) at VAP onset. Patients with polybacterial VAP were more likely ( < 0.05) to be comatose (22.2 vs. 52.0%) and had a higher SAPS II score (median [IQR] 45.0 [35.25-51.1] vs. 50.0 [40.5-60.75]) at VAP onset. Polybacterial MDR spp. VAP had distinct demographic and clinical characteristics compared to monobacterial, and was associated with poorer outcomes.
由多重耐药（MDR）菌引起的呼吸机相关性肺炎（VAP）是重症监护病房（ICU）患者中常见的感染。VAP单菌感染和多菌感染病例的患者特征及死亡率可能有所不同。在立陶宛一所转诊大学医院的四个ICU中进行了一项为期3年的单中心回顾性研究，旨在比较单菌和多菌MDR菌属VAP发作的临床特征及60天ICU全因死亡率。在分析的86例MDR菌属VAP发作中，50例（58.1%）为多菌感染。多菌感染发作的60天死亡率更高（P<0.05）：总体上（50.0%对27.8%），VAP发作时病情较轻（序贯器官衰竭评估（SOFA）<8）的亚组中（45.5%对15.0%），即使接受了适当治疗（41.7%对12.5%），以及广泛耐药（XDR）菌属亚组中（46.4%对17.6%）。多菌感染发作的ICU死亡率（44.0%对22.5%）也更高。单菌MDR菌属VAP与既往住院史（61.1%对40.0%）、糖尿病（30.6%对5.8%）、肥胖（30.6%对4.7%）、既往抗生素治疗（77.8%对52.0%）、既往头孢菌素治疗（66.7%对36.0%）以及VAP发作时SOFA心血管评分≥3（44.4%对10.0%）相关。多菌VAP患者在VAP发作时更易昏迷（22.2%对52.0%），且序贯急性生理学及慢性健康状况评分系统（SAPS）II评分更高（中位数[四分位间距]45.0[35.25 - 51.1]对50.0[40.5 - 60.75]）。与单菌感染相比，多菌MDR菌属VAP具有不同的人口统计学和临床特征，且与更差的预后相关。
