印度一家神经重症监护病房呼吸机相关性肺炎的发病率、危险因素、微生物学及转归：一项前瞻性观察研究
Incidence, Risk Factors, Microbiology and Outcomes of VAP at an NCU in India: A Prospective Observational Study.
作者信息
Zirpe Kapil, Kapse Upendra, Sharma Akansha, Kulkarni Atul P, Gurav Sushma, Tiwari Anand, Bhujbal Chaitanya, Deshmukh Abhijeet, Suryawanshi Prasad, Pote Prajakta, Bhoyar Abhaya, Zirpe Kaustubh, Suryawanshi Rupali, Sharma Rahul, Dhawad Piyush, Vaidya Hrishikesh
机构信息
Department of Neurotrauma, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India.
Department of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
出版信息
Indian J Crit Care Med. 2025 Apr;29(4):308-313. doi: 10.5005/jp-journals-10071-24948.
BACKGROUND
Ventilator-associated pneumonia (VAP) remains a major challenge while managing ventilated critically ill patients in neurocritical care units (NCUs).
MATERIALS AND METHODS
This was a prospective, single-center, observational study. All adult patients admitted to our NCU requiring mechanical ventilation (MV) for >48 hours were screened for VAP as per clinical pulmonary infectious score (CPIS) criteria. The primary outcome was the incidence of VAP in the ICU. Secondary outcomes were risk factors, microbiology, percentage of MDR/XDR organisms, mortality, and length of stay (LOS) of VAP.
RESULTS
A total of 24.94% (114 of 457) patients developed VAP. The incidence of VAP was 39.43/1000 ventilator days. Multivariate analysis of the risk factors identified, male gender, low Glasgow coma scale (GCS) of 3-8, prolonged ventilation, and diabetes mellitus as significant risk factors for the development of VAP ( < 0.05). (31.58%), (28.95%), and (13.16%) were the most common organisms responsible for VAP. Most of these isolates were multidrug resistant (MDR) (81.58%), and extensively drug-resistant (XDR) organisms (12.28%). Although VAP patients had longer ICU-LOS (26.2 ± 24.2 vs 11.8 ± 6.9 days, < 0.0001), it did not affect the mortality (18.4% for VAP vs 14.3% for non-VAP, = 0.5).
CONCLUSION
Ventilator-associated pneumonia has a high incidence of 39.43 per 1,000 ventilator days in the Indian neurocritical care setting.
HOW TO CITE THIS ARTICLE
Zirpe K, Kapse U, Sharma A, Kulkarni AP, Gurav S, Tiwari A, . Incidence, Risk Factors, Microbiology and Outcomes of VAP at an NCU in India: A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):308-313.
背景
在神经重症监护病房（NCU）对重症机械通气患者进行管理时，呼吸机相关性肺炎（VAP）仍然是一项重大挑战。
材料与方法
这是一项前瞻性、单中心观察性研究。按照临床肺部感染评分（CPIS）标准，对入住我院NCU且需要机械通气（MV）超过48小时的所有成年患者进行VAP筛查。主要结局是ICU中VAP的发生率。次要结局包括危险因素、微生物学、多重耐药/广泛耐药菌的比例、死亡率以及VAP患者的住院时间（LOS）。
结果
共有24.94%（457例中的114例）患者发生VAP。VAP发生率为每1000个呼吸机日39.43例。对已确定的危险因素进行多因素分析，结果显示男性、格拉斯哥昏迷量表（GCS）评分为3 - 8分、通气时间延长以及糖尿病是发生VAP的显著危险因素（P<0.05）。肺炎克雷伯菌（31.58%）、鲍曼不动杆菌（28.95%）和铜绿假单胞菌（13.16%）是导致VAP最常见的病原体。这些分离株大多为多重耐药菌（MDR，81.58%）和广泛耐药菌（XDR，12.28%）。虽然VAP患者的ICU住院时间更长（26.2±24.2天 vs 11.8±6.9天，P<0.0001），但这并未影响死亡率（VAP患者为18.4%，非VAP患者为14.3%，P = 0.5）。
结论
在印度神经重症监护环境中，呼吸机相关性肺炎的发生率较高，为每1000个呼吸机日39.43例。
如何引用本文
Zirpe K, Kapse U, Sharma A, Kulkarni AP, Gurav S, Tiwari A, 等。印度一家NCU中VAP的发生率、危险因素、微生物学及结局：一项前瞻性观察性研究。《印度重症医学杂志》2025；29(4):308 - 313。
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