Pujol M, Corbella X, Peña C, Pallares R, Dorca J, Verdaguer R, Diaz-Prieto A, Ariza J, Gudiol F
Department of Infectious Diseases, Hospital de Bellvitge, University of Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 1998 Sep;17(9):622-8. doi: 10.1007/BF01708344.
Over the 5-year period from 1990 to 1994, a prospective cohort study was conducted to define the clinical and epidemiological characteristics of ventilator-associated methicillin-resistant Staphylococcus aureus (MRSA) pneumonia acquired during a large-scale outbreak of MRSA infection. Of 2411 mechanically ventilated patients, 347 (14.4%) acquired MRSA, 220 (63.4%) had MRSA positive respiratory tract samples and 41 (18.6%) developed ventilator-associated MRSA pneumonia. The overall attack rate for ventilator-associated MRSA pneumonia was 1.56 episodes/1000 ventilator days, but annual attack rates varied according to the trend of the outbreak (range 4.9-0.2). In comparison with methicillin-sensitive Staphylococcus aureus (MSSA), which was implicated in 98 episodes of ventilator-associated pneumonia, MRSA caused exclusively late-onset ventilator-associated pneumonia, while MSSA caused both early-onset [55 of 98 (56.1%) episodes] and late-onset [43 of 98 (43.8%) episodes] ventilator-associated pneumonia. Logistic regression analysis of all patients with Staphylococcus aureus pneumonia revealed intubation for more than 3 days (odds ratio (OR),1.11; confidence interval (CI):1.03-1.18) and prior bronchoscopy (OR,5.8; CI,1.85-18.19) to be independent variables associated with MRSA pneumonia. The results indicate that MRSA ventilator-associated pneumonia is a frequent complication in intensive care patients, manifesting itself as late-onset pneumonia in patients who have been intubated for prolonged periods and/or have often undergoing previous bronchoscopy.
在1990年至1994年的5年期间，开展了一项前瞻性队列研究，以确定在耐甲氧西林金黄色葡萄球菌（MRSA）感染大规模暴发期间获得的呼吸机相关性MRSA肺炎的临床和流行病学特征。在2411例机械通气患者中，347例（14.4%）获得了MRSA感染，220例（63.4%）呼吸道样本MRSA呈阳性，41例（18.6%）发生了呼吸机相关性MRSA肺炎。呼吸机相关性MRSA肺炎的总体发病率为1.56例/1000呼吸机日，但年发病率根据暴发趋势而有所不同（范围为4.9 - 0.2）。与98例呼吸机相关性肺炎由甲氧西林敏感金黄色葡萄球菌（MSSA）引起相比，MRSA仅导致晚发性呼吸机相关性肺炎，而MSSA导致早发性[98例中的55例（56.1%）]和晚发性[98例中的43例（43.8%）]呼吸机相关性肺炎。对所有金黄色葡萄球菌肺炎患者进行的逻辑回归分析显示，插管超过3天（比值比（OR）为1.11；置信区间（CI）：1.03 - 1.18）和先前进行过支气管镜检查（OR为5.8；CI为1.85 - 18.19）是与MRSA肺炎相关的独立变量。结果表明，MRSA呼吸机相关性肺炎是重症监护患者常见的并发症，在长期插管和/或经常接受支气管镜检查的患者中表现为晚发性肺炎。
