VENTILATOR-ASSOCIATED PNEUMONIA BY STAPHYLOCOCCUS-AUREUS - COMPARISON OF METHICILLIN-RESISTANT AND METHICILLIN-SENSITIVE EPISODES
VENTILATOR-ASSOCIATED PNEUMONIA BY STAPHYLOCOCCUS-AUREUS - COMPARISON OF METHICILLIN-RESISTANT AND METHICILLIN-SENSITIVE EPISODES
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DOI：
10.1164/ajrccm.150.6.7952612
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发表时间：
1994-12-01
影响因子：
24.7
通讯作者：
RODRIGUEZROISIN, R
中科院分区：
文献类型：
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作者：
RELLO, J;TORRES, A;RODRIGUEZROISIN, R
前瞻性分析了所有由金黄色葡萄球菌引起的呼吸机相关性肺炎（VAP）发作30个月。对甲氧西林敏感的S.金黄色葡萄球菌（MSSA）38例，耐甲氧西林的S.金黄色葡萄球菌（MRSA）11例。两组在性别、基础疾病严重程度、既往手术史、肾衰竭、糖尿病、心脏病和昏迷方面相似。MRSA感染者更有可能在感染前接受过类固醇治疗（相对危险度[RR] = 3.45，95%置信区间[Cl] = 1.38-8.59），已通气> 6天（RR = 2.03，95%CI = 1.36-3.03），年龄大于25岁（RR = 1.50，95%CI = 1.09-2.06），既往有慢性阻塞性肺疾病（RR = 2.76，95% CI = 0.89-8.56）。MRSA感染者比MRSA感染者更容易发生颅脑损伤（RR = 1.94，95%CI = 1.22-3.09）。所有MRSA VAP患者既往均接受过抗生素治疗，而MSSA感染患者中只有21.1%接受过抗生素治疗（p < 0.000001）。两组的脓胸发生率相似;然而，MRSA组的菌血症和感染性休克更常见。最后，在MRSA发作的患者中，与肺炎直接相关的死亡率显著较高（RR = 20.72，95%CI = 2.78-154.35）。对单一微生物事件重复该分析，差异仍具有统计学意义。我们的结论是，MRSA和MSSA菌株感染的患者具有不同的人口统计学特征;以前的抗生素治疗是发展MRSA感染的最重要的危险因素。我们的研究结果表明MRSA VAP比MSSA VAP有更高的菌血症率和更差的结局。
All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. MRSA-infected persons were more likely to have received steroids before developing infection (relative risk [RR] = 3.45, 95% confidence interval [Cl] = 1.38-8.59), to have been ventilated > 6 d (RR = 2.03, 95% Cl = 1.36-3.03), to have been older than 25 yr(RR = 1.50, 95% Cl = 1.09-2.06), and to have had preceding chronic obstructive pulmonary disease (RR = 2.76, 95% Cl = 0.89-8.56) than MSSA-infected patients. MSSA-infected persons were more likely than MRSA-infected patients to have cranioencephalic trauma (RR = 1.94, 95% Cl = 1.22-3.09). All patients with MRSA VAP had previously received antibiotics, compared with only 21.1% of those with MSSA infection (p < 0.000001). The incidence of empyema was similar in both groups; nevertheless, the presence of bacteremia and septic shock was more frequent in the MRSA group. Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% Cl = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection. Our findings suggest that MRSA VAP has a greater bacteremic rate and a worse outcome than MSSA VAP.