Stamatiou Rodopi, Gerovasileiou Efrosyni, Angeli Maria, Deskata Konstantina, Tsolaki Vasiliki, Mantzarlis Konstantinos, Zakynthinos Epameinondas, Makris Demosthenes
Intensive Care Unit, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece.
Department of Biochemistry and Biotechnology, School of Health Sciences, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece.
Microorganisms. 2025 Mar 18;13(3):676. doi: 10.3390/microorganisms13030676.
Mechanically ventilated (MV) patients often develop ventilator-associated pneumonia (VAP) with increased mortality risk, especially in VAP caused by multidrug-resistant (MDR) microorganisms. We evaluated MV patients and monitored VAP presentation, microbiologically confirmed. The patients underwent bronchoalveolar lavage (BAL) and blind bronchial aspiration (AC) at baseline. Systematic bronchial secretion and radiologic assessments were performed daily. The patients were classified as MDR-VAP, non-MDR-VAP, or non-VAP. The APACHE II and SOFA scores, microbiology, inflammatory markers, respiratory system characteristics, and ventilator settings were evaluated. BAL and AC were assessed for total protein levels, cellular number and profile, and IL-1β and TNF-α levels. Of the VAP patients, 46.1% presented with MDR-VAP due to , , , or , and 53.8%-with non-MDR-VAP. The VAP patients had higher APACHE II scores and airway pressure but a lower baseline PO/FIO compared to the non-VAP patients, while PO/FIO was increased in MDR-VAP compared to non-MDR-VAP. BAL protein, IL-1β, and cellular levels were increased in VAP vs. non-VAP and in non-MDR-VAP compared to MDR-VAP. Macrophages and polymorphonuclears were 34.36% and 23.76% in VAP, statistically significant increased compared to non-VAP. Their percentages were also increased in non-MDR-VAP compared to MDR-VAP. These differences imply a different immunological profile in non-MDR-VAP patients. In conclusion, MDR-VAP patients may present significant differences in baseline clinical characteristics and molecular biomarkers, which may help in prompt diagnosis and an improved therapeutic approach.
机械通气（MV）患者常发生呼吸机相关性肺炎（VAP），死亡风险增加，尤其是由多重耐药（MDR）微生物引起的VAP。我们评估了MV患者并监测了经微生物学确诊的VAP表现。患者在基线时接受支气管肺泡灌洗（BAL）和盲法支气管抽吸（AC）。每天进行系统性支气管分泌物和影像学评估。患者被分为MDR-VAP、非MDR-VAP或非VAP。评估了急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分、微生物学、炎症标志物、呼吸系统特征和呼吸机设置。对BAL和AC的总蛋白水平、细胞数量和细胞图谱以及白细胞介素-1β（IL-1β）和肿瘤坏死因子-α（TNF-α）水平进行了评估。在VAP患者中，46.1%表现为因 、 、 或 导致的MDR-VAP，53.8%表现为非MDR-VAP。与非VAP患者相比，VAP患者的APACHE II评分和气道压力更高，但基线动脉血氧分压/吸入氧分数（PO₂/FIO₂）更低，而与非MDR-VAP相比，MDR-VAP患者的PO₂/FIO₂升高。与非VAP相比，VAP以及与MDR-VAP相比，非MDR-VAP患者的BAL蛋白、IL-1β和细胞水平升高。VAP患者的巨噬细胞和多形核细胞分别为34.36%和23.76%，与非VAP相比有统计学意义的增加。与MDR-VAP相比，非MDR-VAP患者中它们的百分比也增加。这些差异表明非MDR-VAP患者具有不同的免疫特征。总之，MDR-VAP患者在基线临床特征和分子生物标志物方面可能存在显著差异，这可能有助于早期诊断和改进治疗方法。
