Malhotra Raj, Horng Helen, Bonne Stephanie, Sifri Ziad, Glass Nina E
Department of Surgery, Division of Trauma and Critical Care Surgery, Rutgers NJMS, Newark, NJ, United States of America.
University Hospital, Pharmacy, Newark, NJ, United States of America.
Surg Open Sci. 2023 Sep 22;16:64-67. doi: 10.1016/j.sopen.2023.09.014. eCollection 2023 Dec.
Ventilator-associated pneumonias (VAPs) are a complication of mechanical ventilation in the intensive care unit (ICU) that increase length of stay, morbidity, and mortality. While identifying and treating infections early is paramount to improving patient outcomes, more and more data demonstrate limited courses of antibiotics improve outcomes. Prolonged (10-14 day) courses of antibiotics have remained the standard of care for pneumonia due to gram-negative bacilli (GNR). We aimed to review our GNR VAPs to assess risk factors for recurrent GNR infections.
We reviewed trauma patients who developed VAP from 02/2019 through 05/2022. Demographics, injury characteristics, and outcomes were reviewed with a focus on pneumonia details including the cultured pathogen(s), antibiotic(s) used, treatment duration, and presence of recurrent infections. We then compared single episode VAPs to multiple episode VAPs among patients infected by GNRs.
Eleven of the fifty trauma patients admitted to the ICU suffered a VAP caused by a GNR. Of these eleven patients, six experienced a recurrent infection, four of which were caused by and two of which were caused by . Among the patients who received ten days of antibiotic treatment, half suffered a recurrence. Although, there was no difference in the microbiology or antibiotic duration between the recurrences and single episodes.
Despite prolonged use of antibiotics, we found that the risk of recurrent or persistent infections was high among patients with VAP due to GNB. Further study is needed to determine optimal treatment to minimize the risk of these recurrences.
Ventilator-associated pneumonia due to gram-negative bacilli is a rare but high morbidity complication in intensive care units. Despite prolonged duration of therapy, these infections still appear to account for many recurrent infections and further study into optimal therapy is warranted.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）机械通气的一种并发症，会延长住院时间、增加发病率和死亡率。虽然早期识别和治疗感染对于改善患者预后至关重要，但越来越多的数据表明，有限疗程的抗生素可改善预后。由于革兰氏阴性杆菌（GNR）导致的肺炎，抗生素的长期（10 - 14天）疗程一直是治疗的标准。我们旨在回顾我们的GNR VAP病例，以评估复发性GNR感染的风险因素。
我们回顾了2019年2月至2022年5月期间发生VAP的创伤患者。回顾了人口统计学、损伤特征和预后，重点关注肺炎细节，包括培养出的病原体、使用的抗生素、治疗持续时间以及复发性感染的情况。然后，我们比较了GNR感染患者中的单次发作VAP和多次发作VAP。
入住ICU的50名创伤患者中有11例发生了由GNR引起的VAP。在这11名患者中，6例经历了复发性感染，其中4例由[未提及具体病原体1]引起，2例由[未提及具体病原体2]引起。在接受10天抗生素治疗的患者中，一半出现了复发。尽管如此，复发和单次发作之间在微生物学或抗生素使用持续时间方面没有差异。
尽管长期使用抗生素，但我们发现，因GNB导致VAP的患者中，复发性或持续性感染的风险很高。需要进一步研究以确定最佳治疗方法，将这些复发的风险降至最低。
重症监护病房中，革兰氏阴性杆菌引起的呼吸机相关性肺炎是一种罕见但发病率高的并发症。尽管治疗时间延长，但这些感染似乎仍导致许多复发性感染，有必要进一步研究最佳治疗方法。
