Clinical outcomes of Pseudomonas aeruginosa pneumonia in intensive care unit patients
Clinical outcomes of Pseudomonas aeruginosa pneumonia in intensive care unit patients
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DOI：
10.1007/s00134-013-2828-9
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发表时间：
2013-04-01
影响因子：
38.9
通讯作者：
Antonelli, Massimo
中科院分区：
文献类型：
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作者：
Tumbarello, Mario;De Pascale, Gennaro;Antonelli, Massimo
我们的目的是确定重症监护病房（ICU）患者铜绿假单胞菌（PA）肺炎的临床特征，以及PA分离株的多药耐药（MDR）和初始抗生素治疗（IIAT）不足对ICU死亡率和机械通气（MV）持续时间的影响。我们对罗马一家大型教学医院18床普通ICU前瞻性收集的数据进行了回顾性分析，意大利。研究队列包括2008-2010年连续诊断的110例经培养证实的PA肺炎成人患者。比较ICU存活组和非存活组，以确定与ICU死亡率相关的因素。在分析的110例PA肺炎病例中，42例（38%）PA分离株为MDR。五十六例（50.9%）接受IIAT，49例（44.5%）在ICU死亡。在逻辑回归分析中，IIAT、糖尿病、较高的简化急性生理学评分（SAPS）II评分和年龄较大与ICU死亡率独立相关。在存活者中，接受IIAT或MDR PA肺炎的患者中位（四分位距，IQR）肺炎后MV发作时间（分别为16.5 [14.5-20]和15 [12-18]天），与初始治疗充分的患者相比（8 [6-13]天，P < 0.001）和那些由非MDR PA引起的感染（10.5 [6.5-13]天，P = 0.01）。我们的研究结果强调了IIAT作为PA肺炎ICU患者死亡率危险因素的重要性。PA分离株中的MDR与IIAT一样，可显著增加MV的需求。
Our aim was to identify the clinical profile of intensive care unit (ICU) patients with Pseudomonas aeruginosa (PA) pneumonia and the impact on ICU mortality and duration of mechanical ventilation (MV) of multidrug resistance (MDR) in the PA isolate and inadequate initial antibiotic therapy (IIAT).We conducted a retrospective analysis of data prospectively collected in the 18-bed general ICU of a major teaching hospital in Rome, Italy. The study cohort consisted of 110 adult patients with culture-confirmed PA pneumonia consecutively diagnosed in 2008-2010. ICU survivor and nonsurvivor groups were compared to identify factors associated with ICU mortality.In 42 (38 %) of the 110 cases of PA pneumonia analyzed, the PA isolate was MDR. Fifty-six (50.9 %) of the patients received IIAT, and 49 (44.5 %) died in ICU. In logistic regression analysis, IIAT, diabetes mellitus, higher Simplified Acute Physiology Score (SAPS) II scores, and older age were independently associated with ICU mortality. Among survivors, those who received IIAT or had MDR PA pneumonia had significantly longer median (interquartile ranges, IQR) periods of post-pneumonia onset MV (16.5 [14.5-20] and 15 [12-18] days, respectively) compared with those whose initial therapy was adequate (8 [6-13] days, P < 0.001) and those whose infections were caused by non-MDR PA (10.5 [6.5-13] days, P = 0.01).Our findings highlight the importance of IIAT as a risk factor for mortality in ICU patients with PA pneumonia. MDR in the PA isolate, like IIAT, can significantly increase the need for MV.