泰国一家三级护理医院中由多重耐药革兰氏阴性菌引起的呼吸机相关性气管支气管炎和呼吸机相关性肺炎的流行病学情况。

Epidemiology of ventilator-associated tracheobronchitis and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria at a tertiary care hospital in Thailand.

作者信息

Kajeekul Rattagarn, Thamlikitkul Visanu, Wonglaksanapimon Suvimon, Rattanaumpawan Pinyo

机构信息

Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

JAC Antimicrob Resist. 2023 Dec 28;6(1):dlad140. doi: 10.1093/jacamr/dlad140. eCollection 2024 Feb.

DOI:10.1093/jacamr/dlad140

PMID:38161966

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10753648/

Abstract

OBJECTIVES

To investigate the epidemiology of MDR Gram-negative bacilli ventilator-associated tracheobronchitis (MDR GNB-VAT) and MDR GNB ventilator-associated pneumonia (MDR GNB-VAP) among mechanically ventilated patients.

METHODS

We conducted a retrospective observational study among hospitalized patients who underwent continuous mechanical ventilation for ≥48 h at Siriraj Hospital, Thailand.

RESULTS

During the 18 month study period, 1824 unique patients underwent continuous mechanical ventilation (12 216 ventilator-days). The cumulative incidences of MDR GNB-VAT and -VAP were 8.4% and 8.3%, respectively. The incidence rates of MDR GNB-VAT and -VAP were 12.52 and 12.44 episodes/1000 ventilator-days, respectively. Among those with VAT, the cumulative incidence and incidence rate of subsequent VAP development within 7 days were 11.76% and 2.81 episodes/1000 ventilator-days, respectively. The median durations of mechanical ventilation before having VAP and VAT were 9 and 12 days, respectively. Multivariate analysis identified three independently associated factors for patients having VAP compared with having VAT: underlying cerebrovascular disease [adjusted OR (aOR): 0.46; 95% CI: 0.27-0.78; = 0.04], previous surgery (aOR: 0.68; 95% CI: 0.57-0.8; < 0.001) and acute renal failure (aOR: 1.75; 95% CI: 1.27-2.40; = 0.001).

CONCLUSIONS

The study revealed high incidences of MDR GNB-VAT and -VAP among mechanically ventilated patients. The independent risk factors for having VAP can help identify patients at risk for developing VAP and who need early weaning from mechanical ventilation.

摘要

目的

调查机械通气患者中多重耐药革兰阴性杆菌所致呼吸机相关性气管支气管炎（MDR GNB-VAT）和多重耐药革兰阴性杆菌所致呼吸机相关性肺炎（MDR GNB-VAP）的流行病学情况。

方法

我们在泰国诗里拉吉医院对接受持续机械通气≥48小时的住院患者进行了一项回顾性观察研究。

结果

在18个月的研究期间，1824例不同患者接受了持续机械通气（12216个呼吸机日）。MDR GNB-VAT和MDR GNB-VAP的累积发病率分别为8.4%和8.3%。MDR GNB-VAT和MDR GNB-VAP的发病率分别为12.52例和12.44例/1000个呼吸机日。在发生VAT的患者中，7天内后续发生VAP的累积发病率和发病率分别为11.76%和2.81例/1000个呼吸机日。发生VAP和VAT前机械通气的中位持续时间分别为9天和12天。多因素分析确定了与发生VAT相比，发生VAP的患者有三个独立相关因素：潜在脑血管疾病[校正比值比（aOR）：0.46；95%可信区间（CI）：0.27-0.78；P=0.04]、既往手术（aOR：0.68；95%CI：0.57-0.8；P<0.001）和急性肾衰竭（aOR：1.75；95%CI：1.27-2.40；P=0.001）。