Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant Gram-negative bacteria
Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibiotic-resistant Gram-negative bacteria
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DOI：
10.1378/chest.08-1116
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发表时间：
2008-08-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, Marin H.
中科院分区：
文献类型：
--
作者：
Kollef, Katherhie E.;Schramm, Garrett E.;Kollef, Marin H.
目的：确定潜在耐药革兰氏阴性菌（PARGNB）[铜绿假单胞菌、不动杆菌属和嗜麦芽窄食单胞菌]引起的呼吸机相关肺炎（VAP）患者30天死亡率和住院费用的预测因素。设计：一项回顾性、单中心、观察性队列研究。地点：巴恩斯犹太医院，一家拥有1，200张床位的城市教学医院。患者：需要住院治疗的成人患者与微生物确认的AIAP归因于PARGNB.Interventions：回顾性数据收集自动化医院，微生物学和药房databases. Measures和主要结果：76例VAP归因于PARGNB的患者被确定超过5年的时间。19例患者（25.0%）在住院期间死亡。在BAL采样后24 h内接受第一剂适当抗生素治疗的患者与BAL采样后> 24 h接受第一剂适当治疗的患者相比，30天死亡率在统计学上较低（17.2% vs 50.0%; p = 0.005）。由不动杆菌属引起的VAP最初最常使用不适当的抗生素治疗方案，其次是嗜麦芽窄食单胞菌和铜绿假单胞菌（66.7% vs 33.3% vs 17.2%; p = 0.017）。总的来说，与适当的抗生素方案相比，最初接受不适当抗生素方案治疗的患者的总住院费用在统计学上相似（68，597 +/-55，466美元vs 86，644 +/-64，433美元; p = 0.390）。这些数据表明，对由PARGNB引起的经微生物证实的VAP进行不适当的初始抗生素治疗与30天死亡率较高相关。由于耐药菌（例如，不动杆菌属）导致的VAP发生率较高，可能需要改变VAP的局部经验性抗生素治疗，以优化适当的初始治疗处方。
Objective: To identify predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia (VAP) attributed to potentially antibiotic-resistant Gram-negative bacteria (PARGNB) [Pseudomonas aeruginosa, Acinetobacter species, and Stenotrophomonas maltophilia].Design: A retrospective, single-center, observational cohort study.Setting: Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.Patients: Adult patients requiring hospitalization with microbiologically confirmed AIAP attributed to PARGNB.Interventions: Retrospective data collection from automated hospital, microbiology, and pharmacy databases.Measurements and main results: Seventy-six patients with VAP attributed to PARGNB were identified over a 5-year period. Nineteen patients (25.0%) died during hospitalization. Patients receiving their first dose of appropriate antibiotic therapy within 24 h of BAL sampling had a statistically lower 30-day mortality rate compared to patients receiving the first dose of appropriate therapy > 24 h after BAL (17.2% vs 50.0%; p = 0.005). VAP due to Acinetobacter species was most often initially treated with an inappropriate antibiotic regimen, followed by S maltophilia and P aeruginosa (66.7% vs 33.3% vs 17.2%; p = 0.017). Overall, total hospitalization costs were statistically similar in patients initially treated with an inappropriate antibiotic regimen compared to an appropriate regimen ($68,597 +/- $55,466 vs $86,644 +/- $64,433; p = 0.390).Conclusions: These data suggest that inappropriate initial antibiotic therapy of microbiologically confirmed VAP attributed to PARGNB is associated with greater 30-day mortality. High rates of VAP attributed to antibiotic-resistant bacteria (eg, Acinetobacter species) may require changes in the local empiric antibiotic treatment of VAP in order to optimize the prescription of appropriate initial therapy.