Bergmans D, Bonten M, Gaillard C, de Leeuw P, van Tiel F, Stobberingh E, van der Geest S
Department of Internal Medicine, University Hospital Maastricht, The Netherlands.
Eur J Clin Microbiol Infect Dis. 1996 Jun;15(6):437-45. doi: 10.1007/BF01691309.
The incidence of tracheal colonization and its association with ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA) was studied prospectively in 530 consecutively admitted mechanically ventilated patients in a general intensive care unit. Furthermore, the clinical spectrum, outcome, and microbiological results of 27 cases of staphylococcal ventilator-associated pneumonia (SVAP) were examined. Ventilator-associated pneumonia was diagnosed by protected specimen brush and/or bronchoalveolar lavage. On admission, 7% of the patients were colonized with MSSA in the trachea. Acquired tracheal colonization was demonstrated in 10% of the patients and occurred less frequently in patients with a hospital stay of > 48 h before ICU admission compared to patients admitted directly to the ICU (6% vs. 15%, p < 0.001). Moreover, colonization was acquired more frequently among trauma and neurological/neurosurgical patients (22%) as compared to surgical and medical patients (7%) (p < 0.0001). Twenty-one patients (4%) developed SVAP, the incident being higher in patients colonized in the trachea with MSSA than in those not colonized (21% vs. 1%), p < 0.00001). Staphylococcal ventilator-associated pneumonia developed more often in trauma and neurological/neurosurgical patients as compared to surgical and medical patients (8% vs. 3%, p < 0.05). Moreover, patients with a hospital stay of < 48 h before admission to the ICU had a higher incidence of SVAP as compared to those with a longer hospital stay before ICU admission (7% vs. 2%, p < 0.01). Crude infection-related mortality was 26%. Preceding colonization with MSSA in the trachea appears to be an important risk factor for the development of SVAP, and patients with a short duration of hospitalization before intensive care unit admission have the highest incidence of ventilator-associated pneumonia caused by MSSA.
在一家综合重症监护病房，对530例连续收治的机械通气患者进行了前瞻性研究，以探讨耐甲氧西林金黄色葡萄球菌（MSSA）引起的气管定植发生率及其与呼吸机相关性肺炎的关系。此外，还对27例葡萄球菌呼吸机相关性肺炎（SVAP）的临床特征、转归及微生物学结果进行了检查。呼吸机相关性肺炎通过保护性标本刷检和/或支气管肺泡灌洗进行诊断。入院时，7%的患者气管内定植有MSSA。10%的患者出现了获得性气管定植，与直接入住重症监护病房的患者相比，入住重症监护病房前住院时间>48小时的患者获得性气管定植的发生率较低（6%对15%，p<0.001）。此外，与外科和内科患者（7%）相比，创伤及神经科/神经外科患者获得定植的频率更高（22%）（p<0.0001）。21例患者（4%）发生了SVAP，气管内定植MSSA的患者发生率高于未定植者（21%对1%，p<0.00001）。与外科和内科患者相比，创伤及神经科/神经外科患者发生葡萄球菌呼吸机相关性肺炎的频率更高（8%对3%，p<0.05）。此外，入住重症监护病房前住院时间<48小时的患者SVAP发生率高于入住重症监护病房前住院时间较长的患者（7%对2%，p<0.01）。粗略的感染相关死亡率为26%。气管内先前定植MSSA似乎是发生SVAP的重要危险因素，重症监护病房入院前住院时间短的患者发生MSSA引起的呼吸机相关性肺炎的发生率最高。
