背景:关于患有肺脓肿的危重患者的流行病学和管理方面的数据很少。
目的:重症肺脓肿患者的临床和微生物学特征,他们是如何在ICU中管理的,ICU死亡的危险因素是什么?
方法:回顾性观察多中心研究,基于ICD-10代码,2015年至2022年在法国。通过多因素logistic回归确定ICU内死亡率相关因素。
结果:我们分析了171例ICU肺脓肿患者。78%为男性,平均年龄为56.5±16.4岁。20.4%是过量饮酒的人,25.2%患有慢性肺病(14%COPD),20.5%有癌症史。总的来说,40.9%的免疫功能低下,38%的医院感染合格。表现出的症状包括62%的疲劳或体重减轻,发热(50.3%)和呼吸困难(47.4%)。报告咯血占21.7%。多微生物感染占35.6%。最常见的病原体是31%的肠杆菌科细菌,金黄色葡萄球菌占22%,铜绿假单胞菌占19.3%。10.5%为真菌感染。几组临床放射学模式与特定的微生物文献相关,可以指导经验性抗生素方案。11.7%的患者进行了经皮脓肿引流术;12.7%的患者进行了手术,12%的患者需要支气管动脉栓塞治疗咯血。ICU死亡率为21.5%,和年龄[OR:1.05(1.02-1.91),P=0.007],ICU入住期间的RRT[OR:3.56(1.24-10.57),P=0.019],和真菌感染[OR:9.12(2.69-34.5),P=0.0006]是多因素logistic回归后死亡率的独立预测因子,而引流或手术没有。
结论:ICU中的肺脓肿是一种罕见但严重的疾病,通常是由具有高比例肠杆菌科细菌的多微生物感染引起的。金黄色葡萄球菌,还有铜绿假单胞菌.经皮引流,超过三分之一的病例需要手术或动脉栓塞.需要进一步的前瞻性研究,重点是一线抗菌治疗和来源控制程序,以改善和规范患者管理。
Data are scarce regarding epidemiology and management of critically ill patients with lung abscesses.
What are the clinical and microbiological characteristics of critically ill patients with lung abscesses, how are they managed in the ICU, and what are the risk factors of in-ICU mortality?
This was a retrospective observational multicenter
study, based on International Classification of Diseases, 10th Revision, codes, between 2015 and 2022 in France. In-ICU mortality-associated factors were determined by multivariate logistic regression.
We analyzed 171 ICU patients with pulmonary abscesses. Seventy-eight percent were male, with a mean age of 56.5 ± 16.4 years; 20.4% misused alcohol, 25.2% had a chronic lung disease (14% COPD), and 20.5% had a history of cancer. Overall, 40.9% were immunocompromised and 38% qualified for nosocomial infection. Presenting symptoms included fatigue or weight loss in 62%, fever (50.3%), and dyspnea (47.4%).
Hemoptysis was reported in 21.7%. A polymicrobial infection was present in 35.6%. The most frequent pathogens were Enterobacteriaceae in 31%, Staphylococcus aureus in 22%, and Pseudomonas aeruginosa in 19.3%. Fungal infections were found in 10.5%. Several clusters of clinicoradiologic patterns were associated with specific microbiological documentation and could guide empiric antibiotic regimen. Percutaneous abscess drainage was performed in 11.7%; surgery was performed in 12.7%, and 12% required bronchial artery embolization for
hemoptysis. In-ICU mortality was 21.5%, and age (OR: 1.05 [1.02-1.91], P = .007], renal replacement therapy during ICU stay (OR, 3.56 [1.24-10.57], P = .019), and fungal infection (OR, 9.12 [2.69-34.5], P = .0006) were independent predictors of mortality after multivariate logistic regression, and drainage or surgery were not.
Pulmonary abscesses in the ICU are a rare but severe disease often resulting from a polymicrobial infection, with a high proportion of Enterobacteriaceae, S aureus, and P aeruginosa. Percutaneous drainage, surgery, or arterial embolization was required in more than one-third of cases. Further prospective studies focusing on first-line antimicrobial therapy and source control procedure are warranted to improve and standardize patient management.