医院获得性细菌性肺炎病原体流行率的变化及其抗菌耐药模式对临床结局的影响：一项倾向评分匹配研究。
Changes in the prevalence of pathogens causing hospital-acquired bacterial pneumonia and the impact of their antimicrobial resistance patterns on clinical outcomes: A propensity-score-matched study.
机构信息
Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
Division of Infectious Diseases, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea.
出版信息
Int J Antimicrob Agents. 2023 Sep;62(3):106886. doi: 10.1016/j.ijantimicag.2023.106886. Epub 2023 Jun 19.
BACKGROUND
This study aimed to evaluate changes in the prevalence of pathogens causing hospital-acquired bacterial pneumonia (HABP) and their antimicrobial resistance patterns in recent years, and to identify risk factors for 28-day all-cause mortality (ACM) in patients with HABP.
METHODS
A propensity-score-matched study was performed by randomly allocating patients with ventilator-associated and non-ventilator-associated bacterial pneumonia admitted to two university hospitals between 2011 and 2021.
RESULTS
In total, 17,250 patients with HABP were enrolled. The annual incidence of Staphylococcus aureus HABP decreased during the study period, while that of Klebsiella pneumoniae HABP increased significantly each year. Over the same period, the resistance rate of S. aureus to methicillin decreased from 88.4% to 64.4%, while the non-susceptibility rate of K. pneumoniae to carbapenems increased from 0% to 38%. HABP caused by A. baumannii [adjusted odds ratio (aOR) 1.50, 95% confidence interval (CI) 1.25-1.79], K. pneumoniae (aOR 1.28, 95% CI 1.16-1.40) and Stenotrophomonas maltophilia (aOR 1.32, 95% CI 1.05-1.66) was a risk factor for 28-day ACM. Patients with HABP caused by methicillin-resistant S. aureus and carbapenem-non-susceptible A. baumannii or K. pneumoniae had a significantly lower probability of survival. HABP with preceding coronavirus disease 2019 (COVID-19) was associated with high 28-day ACM (aOR 5.40, 955 CI 3.03-9.64) and high incidence of bacteraemic pneumonia (aOR 40.55, 95% CI 5.26-312.79).
CONCLUSIONS
This study showed shifting trends in HABP-causing pathogens in terms of annual incidence and resistance rates to major therapeutic antimicrobial agents. HABP-causing bacterial pathogens, their antimicrobial resistance phenotypes, and preceding COVID-19 were significantly associated with progression of HABP to bloodstream infection and 28-day ACM in infected patients.
背景
本研究旨在评估近年来导致医院获得性细菌性肺炎（HABP）的病原体流行率及其抗菌药物耐药模式的变化，并确定 HABP 患者 28 天全因死亡率（ACM）的危险因素。
方法
通过随机分配 2011 年至 2021 年期间在两所大学医院住院的呼吸机相关性和非呼吸机相关性细菌性肺炎患者，进行倾向评分匹配研究。
结果
共纳入 17250 例 HABP 患者。金黄色葡萄球菌 HABP 的年发生率在研究期间下降，而肺炎克雷伯菌 HABP 的年发生率则显著增加。同期，金黄色葡萄球菌对甲氧西林的耐药率从 88.4%降至 64.4%，而肺炎克雷伯菌对碳青霉烯类药物的非敏感性率从 0%升至 38%。鲍曼不动杆菌（调整后的优势比[aOR]1.50，95%置信区间[CI]1.25-1.79）、肺炎克雷伯菌（aOR 1.28，95%CI 1.16-1.40）和嗜麦芽寡养单胞菌（aOR 1.32，95%CI 1.05-1.66）引起的 HABP 是 28 天 ACM 的危险因素。耐甲氧西林金黄色葡萄球菌和碳青霉烯类药物不敏感的鲍曼不动杆菌或肺炎克雷伯菌引起的 HABP 患者的生存率显著降低。HABP 合并新型冠状病毒病 2019（COVID-19）与 28 天 ACM 发生率高（调整后的优势比[aOR]5.40，95%置信区间[CI]3.03-9.64）和菌血症性肺炎发生率高（调整后的优势比[aOR]40.55，95%CI 5.26-312.79）显著相关。
结论
本研究显示，HABP 致病病原体在年度发病率和主要治疗性抗菌药物耐药率方面呈变化趋势。HABP 致病细菌病原体、其抗菌药物耐药表型以及 COVID-19 病史与 HABP 进展为血流感染和感染患者 28 天 ACM 显著相关。
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