CAJ | 학술논문

目的验证ICU患者呼吸机相关性肺炎(YAP)与多重耐药菌感染(MDRO)的关联.方法通过医院感染实时监测系统,前瞻性实时追踪某医院ICU建立的人工气道患者发生VAP情况.研究队列为2013年1月1日至12月31日建立人工气道的所有患者.采用巢式病例对照研究设计,采用多因素logistic回归分析比较两组间获得性MDRO的差异.结果共有142例VAP及342例非VAP患者进入研究.两组间患者入院天数、入住ICU天数、机械通气天数的差异有统计学意义(P值均≤0.001).相对于MDRO阴性患者,MDRO定植或者感染者发生VAP的风险增大3.05倍(调整OR=4.05,95％CI:2.51～ 5.46).VAP患者中,相对于MDRO阴性患者,MDRO阳性患者机械通气天数、抗菌药物使用天数显著增加(P值均＜0.001).结论 ICU机械通气患者中MDRO定植和感染显著增加VAP的发病风险,导致患者住院时间延长,加剧用药选择难度.
목적 험증ICU환자호흡궤상관성폐염(YAP)여다중내약균감염(MDRO)적관련.방법 통과의원감염실시감측계통,전첨성실시추종모의원ICU건립적인공기도환자발생VAP정황.연구대렬위2013년1월1일지12월31일건립인공기도적소유환자.채용소식병례대조연구설계,채용다인소logistic회귀분석비교량조간획득성MDRO적차이.결과 공유142례VAP급342례비VAP환자진입연구.량조간환자입원천수、입주ICU천수、궤계통기천수적차이유통계학의의(P치균≤0.001).상대우MDRO음성환자,MDRO정식혹자감염자발생VAP적풍험증대3.05배(조정OR=4.05,95％CI:2.51～ 5.46).VAP환자중,상대우MDRO음성환자,MDRO양성환자궤계통기천수、항균약물사용천수현저증가(P치균＜0.001).결론 ICU궤계통기환자중MDRO정식화감염현저증가VAP적발병풍험,도치환자주원시간연장,가극용약선택난도.
Objective The aim of this study was to explore the association between acquired multi-drug resistant organism (MDRO) and ventilator-associated pneumonia (VAP) in patients hospitalized at the intensive care unit (ICU).Methods Real-time monitoring system for hospital infection was used to track VAP patients.The period of study was from January 1,2013 to December 31,2013.Both a nested case-control study design and logistic multivariable regression model were performed to explore the association.Results A total of 142 VAP cases and 342 non-VAP controls were available in this study.Duration of Hospital stay,ICU stay and mechanical days were statistically significant between the case and the control group (P≤0.001).Compared with MDRO negative patient,the MDRO colonization or infection patients showed an 3.05-time increase on the risk of VAP (adjusted OR=4.05,95％ CI:2.51-5.46).Remarkably,MDRO-positive patients were significantly associated with increased duration of mechanical ventilation and antimicrobial drug use (P＜0.001).Conclusion MDRO colonized and infection patients would significantly increase the risks of VAP,with prolonged hospitalization and ICU stay.Effective measures should be taken to promote and control patient' s safety at the hospital.