Objective To study the risk factors and prognosis of hospital acquired pneumonia( HAP)caused by carbapenem-resistant Acinetobacter baumannii( CRAB) . Methods By a case-control study, the data of 44 cases of HAP caused by CRAB fromJan 2005 to Dec 2007 in Nanfang Hospital were analyzed. 66 cases of HAP caused by Carbapenem-susceptible A. baumannii ( CSAB) were selected randomly at the same time as control. Univariate analysis( T test and chi-square test) and multivariate logistic regression were used for statistics analysis. Results Univariate analysis revealed that five factors associated with the infection caused by CRAB were APACHE Ⅱ score ≥ 16, chronic pulmonary disease ( COPD/ bronchiectasis ) , imipenem/meropenem and fluoroquinolone used 15 days before isolation of CRAB, and early combination therapy of antibiotics. Multivariate logistic regression analysis identified two independent factors as APACHEⅡ score ≥16( OR=6. 41, 95% CI 2. 20-18. 67) and imipenem/meropenemused 15 days before isolation of CRAB( OR =6. 33,95% CI 1. 83-21. 87) . Of 44 cases of CRAB infections, 14 patients died and 30 patients survived. Univariate analysis revealed that two factors associated with poor prognosis were organ failure and clinical pulmonary infection score( CPIS) rise after three-day treatment. According to multivariate logistic regression analysis, only CPIS rise after three-day treatment ( OR =7. 01, 95% CI 1. 23-40. 03) was an independent predictive factor. Conclusions APACHEⅡ score ≥ 16 and imipenem/meropenem used 15 days before isolation of CRAB were independent risk factors for CRAB infection. CPIS rise after three-day treatment was a predictive factor for the prognosis of CRAB infection.
To evaluate the clinical efficacy and safety of piperacillin/ tazobactam in the treatment of hospital acquired pneumonia( HAP) . Methods A multicenter, open-labeled, non-comparative clinical trial was conducted. Patients with HAP were administered intravenously with piperacillin /tazobactam( 4. 5 g) every 8 h for 7-14 days. Results A total of 250 patients were enrolled in this study and 246 subjects were clinical valuable. At the end point, the clinical efficacy rate was 81. 7% ( 201 /246) and the bacterial eradication rate was 74. 1% ( 83 /112) . The rate of drug related adverse events was 2. 8% ( 7 /250) , in which 4 cases had clinical significance ( rash, dyspnea, injection site pain and diarrhea, respectively) and 3 cases had abnormal laboratory findings ( hepatic dysfuction , eosinophilia and so on ) . All events were mild and transient . Conclusions Piperacillin/ tazobactamis effective and safe in the treatment of HAP, therefore, it is recommended as one of the first-line antibiotics to treat the patients with HAP.
Objective To investigate the genetic polymorphism of methicillin resistant Staphylococcus aureus ( MRSA) isolated from hospital acquired pneumonia. Methods Seventy-four hospitalized patients were diagnosed as noscomial MRSA pneumonia from January 2007 to January 2008 in Xinhua Hospital, Shanghai Jiaotong Univesity. The genes of MRSA were amplified by random amplified polymorphic DNA typing ( RAPD) assay in 82 clinical isolates from these patients. Results Two to 15 amplified DNA fragments were observed in agarose gel and they were classified into 11 genotypes. Genotypes Ⅲ, Ⅵ and Ⅶ ( 32. 56% , 30. 23% and 13. 95% , respectively) were mainly isolated from the ICU. Both independent genotypes and overlapping genotpyes with those from ICU were identified in isolates from the departments of geriatrics, emergency and respiratory medicine. Outbreak or cluster cases ( 48. 65% ) were found in 36 of the 74 patients while all outbreak cases occurred in the ICU. Conclusions Noscomial MRSA pneumonia is easy to disseminate and small-scale outbreak may occur especially in ICU. RAPD is valuable for identification and prevention of the spread of MRSA in hospital.
Objective To analyze the etiology, risk factors, and prognosis of late-onset hospitalacquired pneumonia ( L-HAP) in respiratory ICU. Methods In this retrospective case control study, 30 L-HAP patients and 30 patients without HAP in respiratory ICU were enrolled to investigate the features and risk factors of L-HAP. Stratification was made according to the onset time of L-HAP. The etiology and pathogen distribution at each stage were described and analyzed. Results Univariate analysis revealed thatunconsciousness, aspiration, mechanical ventilation, hypoalbuminemia, and long-term use of proton pump inhibitor were significantly associated with L-HAP. Logistic regression analysis revealed that mechanical ventilation( OR = 8. 7) and hypoalbuminemia ( OR = 20. 4) were independent risk factors for L-HAP. The L-HAP patients had longer stay in hospital, long-termantibiotic use, and higher mortality compared with the patients without HAP. For the patients whose L-HAP onset time within 6-14 days, the dominated pathogens were Acinetobacter baumannii and Klebsiella pneumonia. For those within 15-28 days, the dominated pathogens were Pseudomonas aeruginosa, Acinetobacter baumanni, and Staphylococcus aureus. For those beyond 29 days, the dominated pathogens were Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Conclusions Mechanical ventilation and hypoalbuminemia are independent risk factors for L-HAP. The pathogen features of L-HAP are quite different at different inhospital stage.
【摘要】 目的 〖JP2〗研究质子泵抑制剂（PPI）是否为危重患者发生医院获得性肺炎的危险因素。 方法 收集2002年6月-2009年6月收治的198例重症患者资料，分为使用PPI组（96例）和未使用PPI组（102例）。采用logistic回归分析PPI使用情况和医院获得性肺炎的关系。 结果 使用PPI组肺炎的发生率较高（26.9%），尤其是PPI使用时间超过7 d者（37.5%）。在不同的多变量logistic回归模型中，分别用APACHE Ⅱ评分和入住重症监护室原因校正后，使用PPI以及使用天数均是医院获得性肺炎发生的危险因素（P=0.031，OR＝2.230，95%CI：1.957~2.947；P=0.002，OR＝1.824，95%CI：1.457~2.242）。 结论 长时间应用PPI可能是增加ICU患者发生医院获得性肺炎的一种风险因素。【Abstract】 Objective To identify whether proton pump inhibitors (PPI) is a risk factor of hospital-acquired pneumonia (HAP) in critical patients. Methods The clinical data of the critical patients admitted to ICU from June 2002 to June 2009 were retrospectively analyzed. A total of 198 patients were divided into two groups: 96 in PPI group and 102 in non-PPI group. The relationship between PPI and HAP was analyzed by logistic regression. Results The patients in PPI group had a higher risk of HAP (26.9%), especially who were treated with PPI more than 7 days (37.5%). Adjusted by APACHE Ⅱ score and reason for admission to ICU, PPI therapy and the using duration of PPI were both the risk factors of HAP in different multiple logistic models (P=0.031, OR=2.230, 95%CI: 1.957-2.947; P=0.002, OR=1.824, 95%CI: 1.457-2.242). Conclusion Long-term use of PPI is a risk factor of HAP.
目的:探讨非人工气道患者医院获得性肺炎(HAP)发生的危险因素。方法:收集北京丰台医院2006 年10 月至2008 年9 月确诊HAP 117 例非人工气道患者作为观察组,与同期未发生HAP 的117 例非人工气道患者作为对照组,采用单因素和logistic 多因素回归分析。结果:单因素分析显示年龄、吸烟、中枢神经系统疾病、慢性阻塞性肺疾病(COPD)/支气管扩张、心力衰竭、糖尿病、意识障碍、被动体位、误吸、制酸剂、抗菌素和外科手术12 种因素差异有统计学意义(Plt;0.05),是HAP 患病的可能危险因素。而无创呼吸机通气不增加HAP 发生的危险。但是logistic 多因素回归分析确定年龄、COPD/支气管扩张和外科手术是非人工气道患者HAP 发生的独立危险因素。结论:年龄、COPD/支气管扩张和外科手术是非人工气道患者HAP 发生的危险因素。
Objective To study the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) and explore the related risk factors, so as to provide valuable clinical reference for prevention and treatment of HAP. Methods A case-control study was conducted in a 3700-bed tertiary hospital. Nosocomial infections reported from January 2014 to December 2014 were investigated. A total of 419 inpatients with HAP were enrolled in as a study group, and 419 inpatients without nosocomial infection in the same period and department, with same gender, underlying diseases, and same age, were chosen as a control group. Risk factors of HAP, distribution and drug resistance of pathogens of HAP were analyzed. Results The incidence rate of HAP was 0.62% and the mortality rate was 19.81%. Multivariate analysis identified chronic lung diseases, admission in ICU, two or more kinds of antibiotics used, hospitalization time≥5 days, cerebrovascular disease, and mechanical ventilation were significant risk factors. Totally 492 strains of pathogens were isolated, including 319 strains of gram-negative bacteria, 61 strains of gram-positive bacteria, 112 strains of fungi.Acinetobacter baumannii,Klebsiella pneumonia,Candida albicans,Pseudomonas aeruginosa,Candida glabrata ranked the top five predominant pathogens. Drug resistance rates ofAcinetobacter baumannii to commonly used antibiotics were higher than 75%. Drug resistance rates ofKlebsiella pneumoniae to piperacillin and third-generation cephalosporin were higher than 50%. Conclusions HAP prevails in patients with hospitalization time≥5 days, admission in ICU, cerebrovascular diseases, two or more antibiotics combined used, chronic lung diseases, and mechanicalventilation. It is associated with increased length of hospital stay, decreased quality of life, and elevated morbidity and mortality. The main pathogens of HAP are Gram-negatives.Acinetobacter baumannii andKlebsiella pneumoniae are resistant to the common antibiotics in different degree.
Since 2016, the guidelines for the management of adults with hospital-acquired pneumonia (HAP) / ventilator-associated pneumonia (VAP) have been updated in the United States, Europe, and China, respectively. The differences among these guidelines are demonstrated in this paper. The definition of VAP, how to evaluate the effect of anti-infection therapy, and the prevention strategy are controversial. The consensuses contain diagnostic value of respiratory secretions achieved by noninvasive way for VAP and shorter anti-infection course for VAP. Importantly, pathogenic spectrum for HAP in China is different from others, which is essential for clinical practice.
ObjectiveTo investigate the impact of electrical impedance tomography (EIT) as a means of assessing and guiding pulmonary rehabilitation chest physiotherapy (CPT) in hospital-acquired pneumonia (HAP) patients on the time to symptom improvement, cost of hospitalisation, length of stay and patient satisfaction with pulmonary rehabilitation. MethodsNinety-six patients with HAP requiring pulmonary rehabilitation were included in the study and were divided into control group and experimental group using the random number table method. Patients in both groups underwent pulmonary rehabilitation CPT in addition to clinical treatment for HAP, twice daily for 20 minutes each time. EIT was added to experimental group as a means of assessment and guidance, with dynamic review prior to treatment and real-time adjustment of treatment based on the results. The primary outcome indicator was a comparison of the change in clinical pulmonary infection score (CPIS) after the start of treatment in both groups, and secondary outcome indicators were a comparison of the length of HAP hospitalisation, HAP-related cost, and patient satisfaction with pulmonary rehabilitation in both groups. ResultsDuring the study, 8 patients terminated airway clearance due to the aggravation of the disease, and 1 patient referral. Finally, 43 patients in the study control group and 44 patients in the experimental group were included. There was a significant difference in CPIS between the test group and the control group on 3rd and 7th day after starting airway clearance (P<0.05). Compared with the control group, there were significant differences in the length of HAP hospitalisation, HAP-related cost, and patient satisfaction with airway clearance in the test group (P<0.01). ConclusionThe use of EIT allows real-time visual monitoring of the distribution of lung ventilation in HAP patients, thus guiding individualized pulmonary rehabilitation treatment, which can shorten the time to symptom improvement, reduce the length and cost of HAP hospitalisation and significantly improve patient satisfaction and compliance with pulmonary rehabilitation.