Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients
Risk factors for pneumonia, and colonization of respiratory tract and stomach in mechanically ventilated ICU patients
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DOI：
10.1164/ajrccm.154.5.8912745
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发表时间：
1996-11-01
影响因子：
24.7
通讯作者：
Gaillard, CA
中科院分区：
文献类型：
--
作者：
Bonten, MJM;Bergmans, DCJJ;Gaillard, CA
采用单因素分析和COX比例风险模型，对141例机械通气患者呼吸机相关性肺炎(VAP)、肠道革兰氏阴性菌(EGb)和假单胞菌在呼吸道和胃内定植的危险因素进行了分析。EGB引起VAP 14例(10%)，假单胞菌引起VAP 19例(13%)。呼吸机持续时间是EGB和假单胞菌引起VAP的重要危险因素，也是这些物种在口咽、胃和气管内获得性定植的重要危险因素。在其他20个变量中，入院时的口咽定植(风险比[HR]=4.5)和入院时的感染(HR=2.7)被选为EGB引起VAP的危险因素。口咽部假单胞菌获得性定植(HR=5.0)是引起VAP的最重要的危险因素。EGB或假单胞菌在胃的定植不是VAP的危险因素。对于使用EGb的获得性口咽定植，只有呼吸时间是危险因素，而先前气管被假单胞菌定植和机械通气时间是这些物种获得性口咽定植的危险因素。在COX模型中，只有呼吸机持续时间与EGb的获得性胃定植显著相关。在口腔和气管被假单胞菌科感染之前的定植是这些物种在胃中后天定植的危险因素。VAP患者死亡12例(46%)，非VAP患者38例(33%)(P=0.21)。综上所述，呼吸机持续时间和上呼吸道定植是EGB或假单胞菌引起VAP的最重要的危险因素。
Risk factors for the development of ventilator-associated pneumonia (VAP) and colonization of the respiratory tract and stomach with enteric gram-negative bacteria (EGB) and Pseudomonadaceae were determined in 141 ventilated patients using univariate analysis and the Cox proportional hazards model. VAP was caused by EGB in 14 patients (10%), and by Pseudomonadaceae in 19 patients (13%). The duration of ventilation was a significant risk factor for VAP caused by EGB and Pseudomonadaceae, and for acquired colonization in oropharynx, stomach, and trachea with these species. Of 20 other variables, oropharyngeal colonization with EGB on admission (hazard ratio [HR] = 4.5) and an infection on admission (HR = 2.7) were selected as risk factors for VAP caused by EGB. Acquired colonization with Pseudomonadaceae in oropharynx (HR = 5.0) was the most important risk factor for VAP caused by these species. Gastric colonization with EGB or Pseudomonadaceae were no risk factors for VAP. For acquired oropharyngeal colonization with EGB only the duration of ventilation was a risk factor, whereas preceding colonization of the trachea with Pseudomonodaceae and duration of ventilation were risk factors for acquired oropharyngeal colonization with these species. In the Cox model, only the duration of ventilation was significantly related to acquired gastric colonization with EGB. Preceding colonization of the orophayrnx and of the trachea with Pseudomonadaceae were risk factors for acquired colonization with these species in the stomach. Twelve patients with VAP (46%) and 38 without VAP (33%) died (p = 0.21). In conclusion, duration of ventilation and colonization of the upper respiratory tract are the most important risk factors for VAP caused by EGB or Pseudomonadaceae.