Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis.
Community-acquired polymicrobial pneumonia in the intensive care unit: aetiology and prognosis.
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DOI：
10.1186/cc10444
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Torres A
中科院分区：
文献类型：
--
作者：
Cillóniz C;Ewig S;Ferrer M;Polverino E;Gabarrús A;Puig de la Bellacasa J;Mensa J;Torres A
ICU住院社区获得性肺炎（CAP）患者多微生物病原学的频次及临床意义研究甚少。本研究的目的是描述重症监护病房（ICU）患者多微生物病原学重症CAP的患病率、临床特征和预后。这项前瞻性观察性研究包括362例连续的成年CAP患者，他们在24小时内入院ICU；196例（54%）患者有明确的病因。39例（11%）病例存在多微生物感染（占病原学确定病例的20%）：33例有两种病原体，6例有三种病原体。多微生物感染中最常见的病原体是肺炎链球菌（n = 28, 72%）、呼吸道病毒（n = 15, 39%）和铜绿假单胞菌（n = 8, 21%）。慢性呼吸系统疾病和急性呼吸窘迫综合征标准是多微生物病因学的独立预测因子。与单微生物病因组相比，多微生物病因组不适当的初始抗菌治疗更常见（39%比10%，P < 0.001），并且是医院死亡率的独立预测因子（调整优势比= 10.79,95%可信区间= 3.97 ~ 29.30;P < 0.001）。然而，与单微生物病因组相比，多微生物病因组的住院死亡率趋势较高（n = 8.21% vs n = 17.11%），差异无统计学意义（P = 0.10）。多微生物性肺炎常见于ICU住院患者。这是不适当的初始抗菌素治疗的一个风险因素，这反过来又独立地预测了医院死亡率。
The frequency and clinical significance of polymicrobial aetiology in community-acquired pneumonia (CAP) patients admitted to the ICU have been poorly studied. The aim of the present study was to describe the prevalence, clinical characteristics and outcomes of severe CAP of polymicrobial aetiology in patients admitted to the ICU. The prospective observational study included 362 consecutive adult patients with CAP admitted to the ICU within 24 hours of presentation; 196 (54%) patients had an established aetiology. Polymicrobial infection was present in 39 (11%) cases (20% of those with defined aetiology): 33 cases with two pathogens, and six cases with three pathogens. The most frequently identified pathogens in polymicrobial infections were Streptococcus pneumoniae (n = 28, 72%), respiratory viruses (n = 15, 39%) and Pseudomonas aeruginosa (n = 8, 21%). Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of polymicrobial aetiology. Inappropriate initial antimicrobial treatment was more frequent in the polymicrobial aetiology group compared with the monomicrobial aetiology group (39% vs. 10%, P < 0.001), and was an independent predictor of hospital mortality (adjusted odds ratio = 10.79, 95% confidence interval = 3.97 to 29.30; P < 0.001). The trend for higher hospital mortality of the polymicrobial aetiology group compared with the monomicrobial aetiology group (n = 8, 21% versus n = 17, 11%), however, was not significantly different (P = 0.10). Polymicrobial pneumonia occurs frequently in patients admitted to the ICU. This is a risk factor for inappropriate initial antimicrobial treatment, which in turn independently predicts hospital mortality.
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DOI：
10.1007/s10096-005-1346-2
发表时间：
2005-06-01
影响因子：
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作者：
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DOI：
10.1164/ajrccm.154.5.8912764
发表时间：
1996-11-01
影响因子：
24.7
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