Abstract：
BACKGROUND: The aim of this study was to determine the clinical predictors of staphylococcal ventilator-associated pneumonia (VAP) and to compare the outcomes of staphylococcal VAP with non-staphylococcal VAP.
METHODS: A retrospective observational study was conducted among adult patients admitted to the medical intensive care unit (MICU) in a tertiary care hospital in India from January 2017 to December 2019. The patients were grouped based on their diagnosis into staphylococcal and non-staphylococcal VAP, and the baseline characteristics, clinical parameters, co-morbidities, and outcome parameters were compared.
RESULTS: Out of 2129 MICU admissions, 456 patients with microbiologically confirmed VAP were included, of which 69 (15.1%) had staphylococcal VAP, and the remaining 387 (84.9%) had non-staphylococcal VAP. Organophosphorus (OP) poisoning was identified as an independent predictor of staphylococcal VAP (odds ratio: 2.57; 95% CI: 1.4 to 4.73). The median duration of mechanical ventilation before VAP diagnosis was less in the staphylococcal VAP group (4 vs. 5 days; p = 0.004). The staphylococcal group also showed a better in-hospital outcome.
CONCLUSIONS: OP poisoning was an independent predictor of staphylococcal VAP. Staphylococcal VAP was diagnosed earlier in patients than non-staphylococcal VAP. Screening for nasal carriage for Staphylococcus, especially in patients with OP poisoning at the time of MICU admission, may help guide antibiotic therapy.
METHODS: A retrospective observational study was conducted among adult patients admitted to the medical intensive care unit (MICU) in a tertiary care hospital in India from January 2017 to December 2019. The patients were grouped based on their diagnosis into staphylococcal and non-staphylococcal VAP, and the baseline characteristics, clinical parameters, co-morbidities, and outcome parameters were compared.
RESULTS: Out of 2129 MICU admissions, 456 patients with microbiologically confirmed VAP were included, of which 69 (15.1%) had staphylococcal VAP, and the remaining 387 (84.9%) had non-staphylococcal VAP. Organophosphorus (OP) poisoning was identified as an independent predictor of staphylococcal VAP (odds ratio: 2.57; 95% CI: 1.4 to 4.73). The median duration of mechanical ventilation before VAP diagnosis was less in the staphylococcal VAP group (4 vs. 5 days; p = 0.004). The staphylococcal group also showed a better in-hospital outcome.
CONCLUSIONS: OP poisoning was an independent predictor of staphylococcal VAP. Staphylococcal VAP was diagnosed earlier in patients than non-staphylococcal VAP. Screening for nasal carriage for Staphylococcus, especially in patients with OP poisoning at the time of MICU admission, may help guide antibiotic therapy.
摘要：
背景：本研究的目的是确定葡萄球菌性呼吸机相关性肺炎（VAP）的临床预测因子，并比较葡萄球菌性VAP与非葡萄球菌性VAP的预后。
方法：对2017年1月至2019年12月在印度一家三级护理医院入住医疗重症监护病房（MICU）的成年患者进行了回顾性观察研究。根据诊断将患者分为葡萄球菌和非葡萄球菌VAP，和基线特征，临床参数,合并症,和结果参数进行了比较。
结果：在2129名MICU住院患者中，纳入456例微生物确诊的VAP患者，其中69人（15.1%）患有葡萄球菌性VAP，其余387例（84.9%）患有非葡萄球菌性VAP。有机磷（OP）中毒被确定为葡萄球菌VAP的独立预测因子（比值比：2.57；95％CI：1.4至4.73）。葡萄球菌性VAP组VAP诊断前机械通气的中位持续时间较短(4vs.5天；p=0.004）。葡萄球菌组也显示出更好的住院结果。
结论：OP中毒是葡萄球菌性VAP的独立预测因子。葡萄球菌性VAP的诊断比非葡萄球菌性VAP更早。检查鼻腔携带葡萄球菌，尤其是在MICU入院时OP中毒的患者中，可能有助于指导抗生素治疗。
方法：对2017年1月至2019年12月在印度一家三级护理医院入住医疗重症监护病房（MICU）的成年患者进行了回顾性观察研究。根据诊断将患者分为葡萄球菌和非葡萄球菌VAP，和基线特征，临床参数,合并症,和结果参数进行了比较。
结果：在2129名MICU住院患者中，纳入456例微生物确诊的VAP患者，其中69人（15.1%）患有葡萄球菌性VAP，其余387例（84.9%）患有非葡萄球菌性VAP。有机磷（OP）中毒被确定为葡萄球菌VAP的独立预测因子（比值比：2.57；95％CI：1.4至4.73）。葡萄球菌性VAP组VAP诊断前机械通气的中位持续时间较短(4vs.5天；p=0.004）。葡萄球菌组也显示出更好的住院结果。
结论：OP中毒是葡萄球菌性VAP的独立预测因子。葡萄球菌性VAP的诊断比非葡萄球菌性VAP更早。检查鼻腔携带葡萄球菌，尤其是在MICU入院时OP中毒的患者中，可能有助于指导抗生素治疗。
