Rongrungruang Yong, Plongla Rongpong, Pleumkanitkul Suwapan, Hantrakun Viriya, Khawcharoenporn Thana
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Infectious Diseases, Department of Medicine and Center of Excellence in Antimicrobial Resistance and Stewardship, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Infect Drug Resist. 2025 Jan 20;18:351-361. doi: 10.2147/IDR.S492299. eCollection 2025.
To describe the top three causative organisms of hospital acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in Thailand.
This multi-center retrospective cohort study included HAP/VAP patients hospitalized in 2019 in three university-affiliated hospitals and a private hospital in Bangkok, Thailand. Medical records of patients with a documented diagnosis of nosocomial pneumonia (NP) were systematically reviewed to collect data on demographic, clinical, microbiological, and 30-day readmission due to NP.
A total of 240 patients were included in the study, comprises patients with VAP (62.9%), HAP (36.7%), and ventilated HAP (vHAP) (0.4%). All of the patients had late-onset NP, occurring after five days of hospitalization with median time to NP of 13 days (interquartile range [IQR] 6-25 days) from admission. The top three causative pathogens of NP were (44.2%), (34.6%), and (28.3%). A high rate of carbapenem resistance (CR) in (92.5%) was observed. Lower rates of CR were observed in (20.6%) and isolates (16.9%). Readmission rate due to NP within 30 days after discharge was less than 2% with median time of 4 days (IQR 3-20 days) after discharge. After diagnosis of NP, 19 patients were transferred to intensive care units with median length of stays of 11 days (IQR 3-24 days). Fifty-one percent of HAP patients received mechanical ventilation support after the diagnosis of NP with median length of mechanical ventilation use of 12 days (IQR 6-22 days).
, with its significant carbapenem resistance, presents a major HAP/VAP pathogens and imposes a substantial burden on healthcare resources in this study. Implementation of regular surveillance for causative organisms of NP and their susceptibility profiles are critical for the success of HAP/VAP management, and reducing the related burden of healthcare resources.
描述泰国医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）的三大致病微生物。
这项多中心回顾性队列研究纳入了2019年在泰国曼谷的三家大学附属医院和一家私立医院住院的HAP/VAP患者。对有医院获得性肺炎（NP）确诊记录的患者病历进行系统回顾，以收集有关人口统计学、临床、微生物学以及因NP导致的30天再入院的数据。
共有240例患者纳入研究，包括VAP患者（62.9%）、HAP患者（36.7%）和通气性HAP（vHAP）患者（0.4%）。所有患者均为迟发性NP，发生在住院5天后，从入院到NP的中位时间为13天（四分位间距[IQR]6 - 25天）。NP的三大致病病原体为 （44.2%）、 （34.6%）和 （28.3%）。观察到 中碳青霉烯耐药（CR）率很高（92.5%）。在 （20.6%）和 分离株（16.9%）中观察到较低的CR率。出院后30天内因NP导致的再入院率低于2%，中位时间为出院后4天（IQR 3 - 20天）。诊断出NP后，19例患者被转入重症监护病房，中位住院时间为11天（IQR 3 - 24天）。51%的HAP患者在诊断出NP后接受了机械通气支持，机械通气使用的中位时间为12天（IQR 6 - 22天）。
具有显著的碳青霉烯耐药性，是主要的HAP/VAP病原体，在本研究中给医疗资源带来了沉重负担。对NP致病微生物及其药敏谱进行定期监测对于HAP/VAP管理的成功以及减轻相关医疗资源负担至关重要。
