危重症成年患者早发性与晚发性呼吸机相关性肺炎：危险因素、结局及微生物谱的比较
Early- vs Late-onset Ventilator-associated Pneumonia in Critically Ill Adults: Comparison of Risk Factors, Outcome, and Microbial Profile.
作者信息
Gunalan Anitha, Sastry Apurba Sankar, Ramanathan Venkateswaran, Sistla Sujatha
机构信息
Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India.
Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India.
出版信息
Indian J Crit Care Med. 2023 Jun;27(6):411-415. doi: 10.5005/jp-journals-10071-24465.
BACKGROUND
Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections, which develops in mechanically ventilated patients after 48 hours of mechanical ventilation. The purpose of this study was to determine the incidence rate, various risk factors, microbiological profile, and outcome of early- vs late-onset ventilator-associated pneumonia (VAP) in medical intensive care unit (MICU).
MATERIALS AND METHODS
This prospective study was conducted on 273 patients admitted to the MICU in JIPMER, Puducherry, from October 2018 to September 2019.
RESULTS
The incidence of VAP was 39.59 per 1000 ventilation days of MICU patients (93/273). Of these, 53 (56.9%) patients had early-onset VAP and 40 (43.1%) had late-onset VAP. Multiple logistic regression analysis showed that steroid therapy, supine head position, coma or impaired unconsciousness, tracheostomy, and re-intubation were found to be independent predictors of early- and late-onset VAP, respectively. Most cases of VAP were caused by Gram-negative bacteria (90.6%), with nonfermenters contributing to 61.8%. The most frequent pathogens causing early-onset VAP were (28.9%) and (20.6%), while in late-onset VAP, (32.9%) and (21.9%) were the most common. Maximum death rate was seen in patients infected with (50%) and (38.5%). There was no significant association between the presence of VAP and mortality among the studied population.
CONCLUSION
The incidence of VAP in our study was high. There were no significant differences in the prevalence of pathogens associated with early-onset or late-onset VAP. Our study shows that early-onset and late-onset VAP have different risk factors, highlighting the need for developing different preventive and therapeutic strategies.
HOW TO CITE THIS ARTICLE
Gunalan A, Sastry AS, Ramanathan V, Sistla S. Early- vs Late-onset Ventilator-associated Pneumonia in Critically Ill Adults: Comparison of Risk Factors, Outcome, and Microbial Profile. Indian J Crit Care Med 2023;27(6):411-415.
背景
呼吸机相关性肺炎（VAP）是最常见的医院获得性感染之一，发生在机械通气患者机械通气48小时后。本研究的目的是确定医学重症监护病房（MICU）中早发性与晚发性呼吸机相关性肺炎（VAP）的发病率、各种危险因素、微生物谱及转归。
材料与方法
本前瞻性研究对2018年10月至2019年9月在本地治里JIPMER的MICU收治的273例患者进行。
结果
MICU患者每1000个通气日中VAP的发病率为39.59（93/273）。其中，53例（56.9%）患者为早发性VAP，40例（43.1%）为晚发性VAP。多因素logistic回归分析显示，类固醇治疗、仰卧头位、昏迷或意识障碍、气管切开术和再次插管分别是早发性和晚发性VAP的独立预测因素。大多数VAP病例由革兰氏阴性菌引起（90.6%），其中非发酵菌占61.8%。引起早发性VAP最常见的病原体是[具体细菌1]（28.9%）和[具体细菌2]（20.6%），而在晚发性VAP中，[具体细菌3]（32.9%）和[具体细菌4]（21.9%）最为常见。感染[具体细菌5]和[具体细菌6]的患者死亡率最高（分别为50%和38.5%）。在研究人群中，VAP的存在与死亡率之间无显著关联。
结论
我们研究中VAP的发病率较高。早发性或晚发性VAP相关病原体的患病率无显著差异。我们的研究表明，早发性和晚发性VAP有不同的危险因素，这突出了制定不同预防和治疗策略的必要性。
如何引用本文
Gunalan A, Sastry AS, Ramanathan V, Sistla S. 重症成人早发性与晚发性呼吸机相关性肺炎：危险因素、转归及微生物谱的比较。《印度重症医学杂志》2023；27(6):411 - 415。
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