Etiology and Risk Factors of Late-Onset Hospital-Acquired Pneumonia in Respiratory Intensive Care Unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHU Linyun ¹ , QU Jieming ² , ZHANG Jing ¹ , HU Bijie ¹ , JIANG Hongni. ¹

Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University. Shanghai, 200032, ChinaCorresponding Author: QU Jie-ming, E-mail: jmqu64@ yahoo. com. cn;

Corresponding author：

Keywords：

Hospital-acquired pneumonia; Intensive care unit; Etiology; Risk factors

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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 that
unconsciousness, 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.

Citation： ZHU Linyun,QU Jieming,ZHANG Jing,HU Bijie,JIANG Hongni.. Etiology and Risk Factors of Late-Onset Hospital-Acquired Pneumonia in Respiratory Intensive Care Unit. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(4): 386-390. doi: Copy

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12.	侯大鹏, 王婧, 杨凤霞, 等. 医院获得性肺炎病原菌的分析与临床研究. 中华医院感染学杂志, 2007, 17: 929-931 .
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14.	周春妹, 胡必杰, 瞿介明. 11441 株革兰阴性杆菌对环丙沙星的耐药性监测. 中国临床医学, 2000 , 7: 182-183 .
15.	Paramythiotou E, Lucet JC, Timsit JF, et al. Acquisition of multiresistant Pseudomona aeuginosa in patients in intensive care units: role of antibiotics wth antipseudomonal activity. Clin Infec Dis, 2004 , 38: 670-677.
16.	Tatman-Otkun M, Gurcan S, Ozer B, et al. Annual trends in antibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations. New Microbiol,2004, 27: 21 -28 .
17.	Poulos CD, Matsumura S, Willey BM, et al. Invitro activities of antimicrobial combinations against Stenotrophomonas maltophilia.Antimicrob Agents Chemother, 1995, 39 : 2220 -2223 .
18.	Low DE. 抗生素的耐药机制. 见: Niederman MS, 主编. 呼吸系统感染. 第2 版. 北京: 人民卫生出版社, 2005, 98-100.
19.	Robert R, Grollier G, DoréP, et al. Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome. J Crit Care, 1999, 14: 114-119 .
20.	李继红, 杨敬芳. 重症监护房肺部感染患者病原菌分布及药敏分析. 临床荟萃, 2005, 20 : 221-222.

1. Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep, 2004, 53: 1-36.
2. 中华医学会呼吸病学分会. 医院获得性肺炎和治疗指南( 草案) . 现代实用医学, 2002, 14: 160-161 .
3. American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital acquired,ventilated-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005 , 171: 388-416 .
4. Beyersmann J, Gastmeier P, Grundmann H, et al. Use of multistate models to assess prolongation of intensive care unit stay due to nosocomial pneumonia. Infect Control Hosp Epidemiol, 2006, 27 :493-499.
5. 胡必杰, 何礼贤, 张杏怡, 等. 我国医院内肺炎流行病学现状: 20世纪90 年代发表论文的荟萃分析. 中华医院感染学杂志,2001, 11: 177-180 .
6. Rangappa P, Moran JL. Outcomes of patients admitted to the intensive care unit with idiopathic pulmonary fibrosis. Crit Care Resuse, 2009, 11: 102-109 .
7. Restrepo MI, Mortensen EM, Velez JA, et al. A comparative study of community acquired pneumonia patients admitted to the ward and ICU. Chest, 2008, 133 : 610-617.
8. Abramczyk ML, Carvalho WB, Carvalho ES, et al. Nosocomial infection in a pediatric intensive care unit in a developing country.Brazilian J Infect Dis, 2003, 7: 375-380.
9. 瞿介明. 呼吸机相关肺炎的发病机制. 中华结核和呼吸杂志,2001, 24: 326-327 .
10. Franciolip P, Chastre J, Langer M, et al. Ventilator associated pneumonia. Clin Microbiol Infect, 1997, 3: S61 -S76.
11. Rotstein C, Evans G, Born A, et al. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol, 2008, 19 : 19 -53.
12. 侯大鹏, 王婧, 杨凤霞, 等. 医院获得性肺炎病原菌的分析与临床研究. 中华医院感染学杂志, 2007, 17: 929-931 .
13. Ehrenstein BP, Craven DE. ICU 内、外的院内获得性肺炎. 见:Niederman MS, 主编. 呼吸系统感染. 第2 版. 北京: 人民卫生出版社, 2005 , 184-199.
14. 周春妹, 胡必杰, 瞿介明. 11441 株革兰阴性杆菌对环丙沙星的耐药性监测. 中国临床医学, 2000 , 7: 182-183 .
15. Paramythiotou E, Lucet JC, Timsit JF, et al. Acquisition of multiresistant Pseudomona aeuginosa in patients in intensive care units: role of antibiotics wth antipseudomonal activity. Clin Infec Dis, 2004 , 38: 670-677.
16. Tatman-Otkun M, Gurcan S, Ozer B, et al. Annual trends in antibiotic resistance of nosocomial Acinetobacter baumannii strains and the effect of synergistic antibiotic combinations. New Microbiol,2004, 27: 21 -28 .
17. Poulos CD, Matsumura S, Willey BM, et al. Invitro activities of antimicrobial combinations against Stenotrophomonas maltophilia.Antimicrob Agents Chemother, 1995, 39 : 2220 -2223 .
18. Low DE. 抗生素的耐药机制. 见: Niederman MS, 主编. 呼吸系统感染. 第2 版. 北京: 人民卫生出版社, 2005, 98-100.
19. Robert R, Grollier G, DoréP, et al. Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome. J Crit Care, 1999, 14: 114-119 .
20. 李继红, 杨敬芳. 重症监护房肺部感染患者病原菌分布及药敏分析. 临床荟萃, 2005, 20 : 221-222.

Chinese Journal of Respiratory and Critical Care Medicine

Etiology and Risk Factors of Late-Onset Hospital-Acquired Pneumonia in Respiratory Intensive Care Unit

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