Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Critical Care Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2024 Oct;57(5):801-811. doi: 10.1016/j.jmii.2024.07.009. Epub 2024 Aug 6.
To understand the microbial profile and investigate the independent predictors for healthcare-associated pneumonia (HCAP) pertinaciously caused by isolates of multidrug-resistant (MDR) Gram-negative bacteria (GNB).
Multicenter ICU patients who received appropriate antibiotic treatments for preceding pneumonia due to MDR GNB isolates and subsequently developed HCAP caused by either MDR GNB (n = 126) or non-MDR GNB (n = 40) isolates in Taiwan between 2018 and 2023 were enrolled. Between the groups of patients with HCAP due to MDR GNB and non-MDR GNB, the proportions of the following variables, including demographic characteristics, important co-morbidities, nursing home residence, physiological severity, intervals between two hospitalizations, steroid use, the tracheostomy tube use alone, ventilator support, and the predominant GNB species involving HCAP, were analyzed using the chi-square test. Logistic regression was employed to explore the independent predictors for HCAP persistently caused by MDR GNB in the aforementioned variables with a P-value of <0.15 in the univariate analysis.
MDR-Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii complex were the three predominant species causing HCAP. Chronic structural lung disorders, diabetes mellitus, intervals of ≤30 days between two hospitalizations, use of the tracheostomy tube alone, and prior pneumonia caused by MDR A. baumannii complex were shown to independently predict the HCAP tenaciously caused by MDR GNB. Conversely, the preceding pneumonia caused by MDR P. aeruginosa was a negative predictor.
Identifying predictors for HCAP persistently caused by MDR GNB is crucial for prescribing appropriate antibiotics.
了解微生物谱，并研究多重耐药（MDR）革兰氏阴性菌（GNB）分离株引起的持续性医疗保健相关性肺炎（HCAP）的独立预测因素。
本研究纳入了 2018 年至 2023 年间在台湾因 MDR GNB 分离株导致的肺炎并随后因 MDR GNB（n=126）或非 MDR GNB（n=40）分离株导致 HCAP 的多中心 ICU 患者。对 MDR GNB 与非 MDR GNB 引起的 HCAP 两组患者，采用卡方检验分析以下变量的比例，包括人口统计学特征、重要合并症、疗养院居住、生理严重程度、两次住院间隔时间、激素使用、单独使用气管造口管、呼吸机支持以及涉及 HCAP 的主要 GNB 种属。采用 logistic 回归分析探讨上述变量中 MDR GNB 持续性 HCAP 的独立预测因素，单因素分析 P 值<0.15。
MDR-肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌复合群是导致 HCAP 的三种主要种属。慢性结构性肺部疾病、糖尿病、两次住院间隔时间≤30 天、单独使用气管造口管以及先前由 MDR 鲍曼不动杆菌复合群引起的肺炎是预测 MDR GNB 持续性 HCAP 的独立因素。相反，先前由 MDR 铜绿假单胞菌引起的肺炎是预测 MDR GNB 持续性 HCAP 的负性因素。
确定 MDR GNB 持续性 HCAP 的预测因素对于适当使用抗生素至关重要。
