RISK-FACTORS FOR NOSOCOMIAL LEGIONELLA-PNEUMOPHILA PNEUMONIA
RISK-FACTORS FOR NOSOCOMIAL LEGIONELLA-PNEUMOPHILA PNEUMONIA
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DOI：
10.1164/ajrccm.149.3.8118629
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发表时间：
1994-03-01
影响因子：
24.7
通讯作者：
MANRESA, F
中科院分区：
文献类型：
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作者：
CARRATALA, J;GUDIOL, F;MANRESA, F
从1985年1月到1990年1月，我们对一家拥有1,000张床位的教学医院的300例院内获得性肺炎进行了前瞻性研究。所有病例均通过高度可靠的技术获得准确的细菌学诊断。嗜肺军团菌共引起36次发作; 22次为地方性发作，14次发生在流行病爆发期间。无一例军团菌肺炎患者在感染前接受过气管插管。目的探讨医院内感染乳酸杆菌的危险因素。对22例嗜肺军团菌肺炎的医院获得性肺炎进行了比较。嗜肺菌与其他细菌感染264例。通过logistic回归分析调整其他变量后，细胞毒化疗（OR = 5.2; 95% CI，1.5 - 17.9）和皮质类固醇的使用（OR = 4.6; 95% CI，1.5 - 14.1）与L呈正相关。而既往抗生素治疗（OR = 0.2; 95%CI，0.1~0.8）和意识下降（OR = 0.2; 95%CI，0.07~0.8）呈负相关。本研究中描述的军团菌肺炎的主要危险因素应在临床方法和疑似医院获得性肺炎患者的经验性治疗中加以考虑。
Over a 5-yr period, from January 1985 to January 1990, we prospectively studied 300 episodes of nosocomial pneumonia in a 1,000-bed teaching hospital. All cases had an accurate bacteriologic diagnosis obtained by means of highly reliable techniques. Legionella pneumophila caused a total of 36 episodes; 22 were endemic and 14 occurred during an epidemic outbreak. No patient with Legionella pneumonia had been intubated before infection. To identify risk factors for nosocomial L. pneumophila pneumonia, we compared the 22 endemic cases of nosocomial pneumonia due to L. pneumophila with the 264 cases due to other bacteria. After adjusting for other variables by means of logistic regression analysis, cytotoxic chemotherapy(OR = 5.2; 95% Cl, 1.5 to 17.9) and use of corticosteroids (OR = 4.6; 95% Cl, 1.5 to 14.1) were positively associated with L. pneumophila pneumonia, whereas previous antibiotic therapy(OR = 0.2; 95% Cl, 0.1 to 0.8) and lowered consciousness (OR = 0.2; 95% Cl, 0.07 to 0.8) were negatively associated. The major risk factors for Legionella pneumonia delineated in this study should be considered in the clinical approach to and empiric therapy of patients with suspected nosocomial pneumonia.