Bonten M J, Bergmans D C, Ambergen A W, de Leeuw P W, van der Geest S, Stobberingh E E, Gaillard C A
Department of Internal Medicine, University Hospital Maastricht, the Netherlands.
Am J Respir Crit Care Med. 1996 Nov;154(5):1339-46. doi: 10.1164/ajrccm.154.5.8912745.
Risk factors for the development of ventilator-associated pneumonia (VAP) and colonization of the respiratory tract and stomach with enteric gram-negative bacteria (EGB) and Pseudomonadaceae were determined in 141 ventilated patients using univariate analysis and the Cox proportional hazards model. VAP was caused by EGB in 14 patients (10%), and by Pseudomonadaceae in 19 patients (13%). The duration of ventilation was a significant risk factor for VAP caused by EGB and Pseudomonadaceae, and for acquired colonization in oropharynx, stomach, and trachea with these species. Of 20 other variables, oropharyngeal colonization with EGB on admission (hazard ratio [HR] = 4.5) and an infection on admission (HR = 2.7) were selected as risk factors for VAP caused by EGB. Acquired colonization with Pseudomonadaceae in oropharynx (HR = 5.0) was the most important risk factor for VAP caused by these species. Gastric colonization with EGB or Pseudomonadaceae were no risk factors for VAP. For acquired oropharyngeal colonization with EGB only the duration of ventilation was a risk factor, whereas preceding colonization of the trachea with Pseudomonodaceae and duration of ventilation were risk factors for acquired oropharyngeal colonization with these species. In the Cox model, only the duration of ventilation was significantly related to acquired gastric colonization with EGB. Preceding colonization of the orophayrnx and of the trachea with Pseudomonadaceae were risk factors for acquired colonization with these species in the stomach. Twelve patients with VAP (46%) and 38 without VAP (33%) died (p = 0.21). In conclusion, duration of ventilation and colonization of the upper respiratory tract are the most important risk factors for VAP caused by EGB or Pseudomonadaceae.
采用单因素分析和Cox比例风险模型，对141例接受机械通气的患者进行了与呼吸机相关性肺炎（VAP）发生以及呼吸道和胃被肠道革兰氏阴性菌（EGB）和假单胞菌科细菌定植相关的危险因素的研究。14例患者（10%）的VAP由EGB引起，19例患者（13%）的VAP由假单胞菌科细菌引起。通气时间是EGB和假单胞菌科细菌所致VAP以及口咽部、胃和气管被这些菌种获得性定植的显著危险因素。在其他20个变量中，入院时口咽部被EGB定植（风险比[HR]=4.5）和入院时存在感染（HR=2.7）被选为EGB所致VAP的危险因素。口咽部被假单胞菌科细菌获得性定植（HR=5.0）是这些菌种所致VAP最重要的危险因素。胃被EGB或假单胞菌科细菌定植并非VAP的危险因素。对于口咽部被EGB获得性定植，仅通气时间是危险因素，而气管先前被假单胞菌科细菌定植以及通气时间是口咽部被这些菌种获得性定植的危险因素。在Cox模型中，仅通气时间与胃被EGB获得性定植显著相关。口咽部和气管先前被假单胞菌科细菌定植是胃被这些菌种获得性定植的危险因素。12例发生VAP的患者（46%）和38例未发生VAP的患者（33%）死亡（p=0.21）。总之，通气时间和上呼吸道定植是EGB或假单胞菌科细菌所致VAP最重要的危险因素。
