目的:了解多药耐药(MDR)革兰阴性菌(GNB)分离株引起的医疗保健相关性肺炎(HCAP)的微生物谱并探讨其独立预测因子。
方法:2018年至2023年间,在台湾,因MDRGNB分离株引起的肺炎而接受适当抗生素治疗,随后发展为由MDRGNB(n=126)或非MDRGNB(n=40)分离株引起的HCAP的多中心ICU患者纳入研究。在MDRGNB和非MDRGNB引起的HCAP患者之间,以下变量的比例,包括人口特征,重要的合并症,养老院住宅,生理严重程度,两次住院之间的间隔,使用类固醇,气管造口管单独使用,呼吸机支持,以及涉及HCAP的主要GNB物种,使用卡方检验进行分析。在单变量分析中,采用Logistic回归分析P值<0.15的上述变量中,MDRGNB持续引起HCAP的独立预测因子。
结果:MDR-肺炎克雷伯菌,铜绿假单胞菌,鲍曼不动杆菌是引起HCAP的三个主要物种。慢性结构性肺病,糖尿病,两次住院之间的间隔≤30天,单独使用气管切开管,和先前由MDR鲍曼不动杆菌复合物引起的肺炎被证明可以独立预测由MDRGNB引起的HCAP。相反,先前由MDR铜绿假单胞菌引起的肺炎是阴性预测因子。
结论:确定由MDRGNB持续引起的HCAP的预测因子对于开具合适的抗生素至关重要。
OBJECTIVE: To understand the microbial profile and investigate the independent predictors for healthcare-associated pneumonia (HCAP) pertinaciously caused by isolates of multidrug-resistant (MDR) Gram-negative bacteria (GNB).
METHODS: Multicenter ICU patients who received appropriate antibiotic treatments for preceding pneumonia due to MDR GNB isolates and subsequently developed HCAP caused by either MDR GNB (n = 126) or non-MDR GNB (n = 40) isolates in Taiwan between 2018 and 2023 were enrolled. Between the groups of patients with HCAP due to MDR GNB and non-MDR GNB, the proportions of the following variables, including demographic characteristics, important co-morbidities, nursing home residence, physiological severity, intervals between two hospitalizations, steroid use, the tracheostomy tube use alone, ventilator support, and the predominant GNB species involving HCAP, were analyzed using the chi-square test. Logistic regression was employed to explore the independent predictors for HCAP persistently caused by MDR GNB in the aforementioned variables with a P-value of <0.15 in the univariate analysis.
RESULTS: MDR-Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii complex were the three predominant species causing HCAP. Chronic structural lung disorders, diabetes mellitus, intervals of ≤30 days between two hospitalizations, use of the tracheostomy tube alone, and prior pneumonia caused by MDR A. baumannii complex were shown to independently predict the HCAP tenaciously caused by MDR GNB. Conversely, the preceding pneumonia caused by MDR P. aeruginosa was a negative predictor.
CONCLUSIONS: Identifying predictors for HCAP persistently caused by MDR GNB is crucial for prescribing appropriate antibiotics.