与感染、和的重症肺炎患者抗生素耐药性及生存分析相关的因素：印度尼西亚雅加达的一项回顾性队列研究
Factors associated with antibiotic resistance and survival analysis of severe pneumonia patients infected with , , and : A retrospective cohort study in Jakarta, Indonesia.
作者信息
Singh Gurmeet, Loho Tonny, Yulianti Mira, Aditianingsih Dita, Zakiyah Laila Fakhriyatuz, Masse Sudirman Fakhruddin, Triono Muhammad Rizki
机构信息
Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia-Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
出版信息
SAGE Open Med. 2024 Aug 27;12:20503121241264097. doi: 10.1177/20503121241264097. eCollection 2024.
BACKGROUND
Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.
METHODS
A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.
RESULTS
The results showed that a total of 333 patients from 415 enrolled were analyzed. (35.4%), (29.3), and (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients ( < 0.05).
CONCLUSIONS
Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.
背景
抗菌药物耐药性是全球公共卫生面临的最重大挑战之一，严重肺炎的风险因素也在不断增加。因此，本研究旨在确定与抗菌药物耐药性相关的因素，并对印度尼西亚雅加达国家转诊医院的单病原体和多病原体严重肺炎患者进行生存分析。
方法
采用回顾性方法，收集了2016年1月至2022年12月期间在印度尼西亚雅加达Cipto Mangunkusumo国家转诊医院重症监护病房收治的严重肺炎患者的二次数据。通过支气管灌洗收集呼吸道标本。此外，进行单因素和多因素分析以分析与抗菌药物耐药性相关的因素。采用对数秩检验生成Kaplan-Meier生存曲线，以比较单病原体、双病原体和多病原体感染患者的30天死亡率。
结果
结果显示，共分析了415名入组患者中的333名。（35.4%）、（29.3%）和（15.4%）是最常分离出的革兰氏阴性病原体。P<0.05表明，与氨基糖苷类、碳青霉烯类和喹诺酮类耐药相关的因素分别是脓毒症、脑血管疾病和呼吸机相关性肺炎。此外，Kaplan-Meier曲线显示，多种病原体会影响严重肺炎患者的生存率（P<0.05）。
结论
脓毒症、脑血管疾病和呼吸机相关性肺炎与严重肺炎患者的抗菌药物耐药性相关。多病原体感染患者的生存率较低。这表明进一步提高对严重肺炎患者经验性抗生素管理和死亡率评估的认识具有重要意义。
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