先前使用碳青霉烯类药物会增加危重症患儿呼吸机相关性肺炎的发生率。

Prior carbapenem exposure increases the incidence of ventilator-associated pneumonia in critically Ill children.

机构信息

Department of Pediatrics, The First People's Hospital of Lianyungang, Xuzhou Medical University Affiliated Hospital of Lianyungang (Lianyungang Clinical College of Nanjing Medical University), Lianyungang, 222000, China.

Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.

出版信息

BMC Infect Dis. 2024 Aug 23;24(1):855. doi: 10.1186/s12879-024-09735-w.

DOI:10.1186/s12879-024-09735-w

PMID:39179984

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11342520/

Abstract

BACKGROUND

Prior antibiotic exposure has been identified as a risk factor for VAP occurrence, making it a growing concern among clinical practitioners. But there is a lack of systematic research on the types of antibiotics and the duration of exposure that influence VAP occurrence in children at current.

METHODS

We retrospectively reviewed 278 children admitted to the Pediatric Intensive Care Unit (PICU) and underwent invasive mechanical ventilation (MV) between January 2020 and December 2022. Of these, 171 patients with MV duration ≥ 48 h were included in the study, with 61 of them developing VAP (VAP group) and the remaining 110 as the non-VAP group. We analyzed the relationship between early antibiotic exposure and VAP occurrence.

RESULTS

The incidence of VAP was 21.94% (61/278). The VAP group had significantly longer length of hospital stay (32.00 vs. 20.00 days, p<0.001), PICU stay(25.00 vs. 10.00 days, p<0.001), and duration of mechanical ventilation(16.00 vs. 6.00 days, p<0.001) compared to the non-VAP group. The mortality in the VAP group was significantly higher than that in the non-VAP group (36.07% vs. 21.82%, p = 0.044). The VAP group had a significantly higher rate of carbapenem exposure (65.57% vs. 41.82%, p = 0.003) and duration of usage (9.00 vs. 5.00 days, p = 0.004) than the non-VAP group. Vancomycin and/or linezolid exposure rates (57.38% vs. 40.00%, p = 0.029) and duration (8 vs. 4.5 days, p = 0.010) in the VAP group were significantly higher than that in the non-VAP group, either. Multivariate logistic regression analysis identified the use of carbapenem (≥ 7 days) (OR = 5.156, 95% CI: 1.881-14.137, p = 0.001), repeated intubation (OR = 3.575, 95% CI: 1.449-8.823, p = 0.006), and tracheostomy (OR = 5.767, 95% CI:1.686-19.729, p = 0.005) as the independent risk factors for the occurrence of VAP, while early intravenous immunoglobulin (IVIG) was a protective factor against VAP (OR = 0.426, 95% CI: 0.185-0.98, p = 0.045).

CONCLUSION

Prior carbapenem exposure (more than 7 days) was an independent risk factor for the occurrence of VAP. For critically ill children, reducing carbapenem use and duration as much as possible should be considered.

摘要

背景

先前的抗生素暴露已被确定为 VAP 发生的危险因素，这在临床医生中引起了越来越多的关注。但目前缺乏关于影响儿童 VAP 发生的抗生素类型和暴露时间的系统研究。

方法

我们回顾性分析了 2020 年 1 月至 2022 年 12 月期间在儿科重症监护病房（PICU）接受侵入性机械通气（MV）且 MV 时间≥48 h 的 278 名儿童。其中，171 名患者的 MV 时间≥48 h 被纳入研究，其中 61 名患者发生 VAP（VAP 组），其余 110 名患者为非 VAP 组。我们分析了早期抗生素暴露与 VAP 发生之间的关系。

结果

VAP 的发生率为 21.94%（61/278）。VAP 组的住院时间（32.00 天比 20.00 天，p<0.001）、PICU 住院时间（25.00 天比 10.00 天，p<0.001）和机械通气时间（16.00 天比 6.00 天，p<0.001）明显长于非 VAP 组。VAP 组的死亡率明显高于非 VAP 组（36.07%比 21.82%，p=0.044）。VAP 组碳青霉烯类药物暴露率（65.57%比 41.82%，p=0.003）和使用时间（9.00 天比 5.00 天，p=0.004）明显高于非 VAP 组。VAP 组万古霉素和/或利奈唑胺暴露率（57.38%比 40.00%，p=0.029）和使用时间（8 天比 4.5 天，p=0.010）也明显高于非 VAP 组。多变量逻辑回归分析发现，碳青霉烯类药物的使用时间（≥7 天）（OR=5.156，95%CI：1.881-14.137，p=0.001）、重复插管（OR=3.575，95%CI：1.449-8.823，p=0.006）和气管切开术（OR=5.767，95%CI：1.686-19.729，p=0.005）是 VAP 发生的独立危险因素，而早期静脉注射免疫球蛋白（IVIG）是 VAP 的保护因素（OR=0.426，95%CI：0.185-0.98，p=0.045）。