多重耐药菌定植对医院获得性肺炎临床特征、抗生素治疗及临床结局的影响
Impact of Multidrug-Resistant Bacterial Colonization on Clinical Characteristics, Antibiotic Treatment, and Clinical Outcomes of Hospital-Acquired Pneumonia.
作者信息
Sim Jae Kyeom, Min Kyung Hoon, Yoo Kwang Ha, Jeon Kyeongman, Chang Youjin, Hong Sang-Bum, Baek Ae-Rin, Park Hye Kyeong, Moon Jae Young, Lee Hyun-Kyung, Cho Woo Hyun, Kim Jin Hyoung, Lee Heung Bum, Kim Changhwan, Bae Soohyun, Gil Hyun-Il, Shin Beomsu, Oh Jee Youn
机构信息
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
出版信息
Lung. 2025 Jan 3;203(1):17. doi: 10.1007/s00408-024-00762-7.
PURPOSE
To determine effects of colonization with multidrug-resistant bacteria (MDRB) in general wards on characteristics, treatment, and prognosis of hospital-acquired pneumonia (HAP).
METHODS
This was a multicenter retrospective cohort study of patients with HAP admitted to 16 tertiary or university hospitals in Korea from July 2019 to December 2019. From the entire cohort, patients who developed pneumonia in general wards with known colonization status before the onset of pneumonia were included in this study. Patients were categorized into a colonization group and a non-colonization group according to MDRB colonization. Patients of the two groups were then compared.
RESULTS
Among a total of 400 patients, 63 were in the MDRB colonization group. HAP caused by MDR-Staphylococcus aureus or MDR-Pseudomonas aeruginosa was more common in the colonization group than in the non-colonization group (24.4% vs. 8.1%, P = 0.006 or 20.0% vs. 5.4%, P = 0.013, respectively). Colonization with certain bacteria was correlated with subsequent infection with the same bacteria. Carbapenem use (36.5% vs. 24.3%, P = 0.044) and appropriateness of initial antibiotics (50.8% vs. 12.8%) were higher in the colonization group than in the non-colonization group. Although in-hospital mortality was similar in the two groups (34.9% vs. 32.9%, P = 0.759), hospital length of stay was longer (38 days vs. 31 days, P = 0.009) and rate of discharge to home was lower (34.1% vs 59.7%, P = 0.002) in the colonization group.
CONCLUSIONS
Colonization with MDRB might influence characteristics and treatment of HAP. However, prognosis of HAP was not associated with MDRB colonization.
目的
确定综合病房中多重耐药菌（MDRB）定植对医院获得性肺炎（HAP）的特征、治疗及预后的影响。
方法
这是一项对2019年7月至2019年12月期间入住韩国16家三级或大学医院的HAP患者进行的多中心回顾性队列研究。在整个队列中，将在综合病房发生肺炎且在肺炎发病前已知定植状态的患者纳入本研究。根据MDRB定植情况将患者分为定植组和非定植组。然后对两组患者进行比较。
结果
在总共400例患者中，63例在MDRB定植组。耐多药金黄色葡萄球菌或耐多药铜绿假单胞菌引起的HAP在定植组比非定植组更常见（分别为24.4%对8.1%，P = 0.006；或20.0%对5.4%，P = 0.013）。某些细菌的定植与随后相同细菌的感染相关。定植组碳青霉烯类药物的使用比例（36.5%对24.3%，P = 0.044）和初始抗生素的恰当性（50.8%对12.8%）高于非定植组。尽管两组的院内死亡率相似（34.9%对32.9%，P = 0.759），但定植组的住院时间更长（38天对31天，P = 0.009），出院回家率更低（34.1%对59.7%，P = 0.002）。
结论
MDRB定植可能影响HAP的特征和治疗。然而，HAP的预后与MDRB定植无关。
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