Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival

被引:39
作者
Vanhems, P
Lepape, A
Savey, A
Jambou, P
Fabry, J
机构
[1] Ctr Hosp Lyon Sud, C CLIN Sud Est, F-69495 Pierre Benite, France
[2] Hop Edouard Herriot, Lab Hyg Hosp, Lyon, France
[3] Ctr Hosp Lyon Sud, Serv Reanimat, Lyon, France
[4] Ctr Hosp Univ, Serv Reanimat, Nice, France
关键词
intensive care unit; nosocomial pneumonia; antimicrobial resistance; risk factors; survival;
D O I
10.1053/jhin.2000.0752
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
The objectives of this study were to identify the risk factors of nosocomial pulmonary infection (NPI) in intensive care units (ICUs) associated with antimicrobial-resistant bacteria (NPI-ARB) and to compare survival after NPI-ARB with NPI due to antimicrobial-sensitive bacteria (NPI-ASB). We analysed data from a surveillance network monitoring nosocomial infections in 27 mixed ICUs in the south-east of France. NPI surveillance data were recorded for 628 patients with documented NPI. The patients were stratified into 2 groups by type of pneumonia: NPI-ASB (445 patients) vs. NPI-ARB (183 patients). Variables associated with NPI-ARB were identified by multivariate logistic regression. Survival was calculated using the Kaplan-Meier method. A medical condition for ICU admission [odds ratio (OR) 1.98, 95% confidence interval (95% CI) 1.35-2.91], transfer from another hospital ward [OR 1.66, 95% CI (1.14-2.42)], a colonized central venous catheter [OR 3.47, 95% CI (1.46-8.21)], a stay of > eight days [OR 1.02, 95% CI (1.03-1.05)] and mechanical ventilation [OR 2.10, 95% CI (1.31-3.36)] were independent risk factors of NPI-ARB. Median survival was 35 days after NPI-ARB and 32 days after NPI-ASB (P = 0.92). Survival after bacterial NPI was not associated with antimicrobial susceptibility. (C) 2000 The Hospital infection Society.
引用
收藏
页码:98 / 106
页数:9
相关论文
共 29 条
[1]  
ACAR J, 1994, PATHOL BIOL, V42, P1
[2]   Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit [J].
AlvarezLerma, F ;
Pellus, AM ;
Sanchez, BA ;
Ortiz, EP ;
Jorda, R ;
Barcenilla, F ;
Maravi, E ;
Galvan, B ;
Palomar, M ;
Serra, J ;
Bermejo, B ;
Mateu, A ;
Quintana, E ;
Palacios, MS ;
Giral, R ;
Gonzalez, V ;
Lerma, FA ;
Mesa, JL ;
Melgarejo, JA ;
Martinez, J ;
Insausti, J ;
Olaechea, P ;
Chanovas, M ;
Gilabert, A ;
Junquera, C ;
Valles, J ;
Palacios, F ;
Calvo, R ;
Mesalles, E ;
Nava, J ;
Santos, A ;
Armengol, S ;
Marzo, D .
INTENSIVE CARE MEDICINE, 1996, 22 (05) :387-394
[3]  
[Anonymous], AM J MED
[4]   Antimicrobial resistance in isolates from inpatients and outpatients in the united states: Increasing importance of the intensive care unit [J].
Archibald, L ;
Phillips, L ;
Monnet, D ;
McGowan, JE ;
Tenover, F ;
Gaynes, R .
CLINICAL INFECTIOUS DISEASES, 1997, 24 (02) :211-215
[5]   Multivariate analysis of risk factors for infection due to penicillin-resistant and multidrug-resistant Streptococcus pneumoniae: A multicenter study [J].
ClavoSanchez, AJ ;
GironGonzalez, JA ;
LopezPrieto, D ;
CanuetoQuintero, J ;
SanchezPorto, A ;
VergaraCampos, A ;
MarinCasanova, P ;
CordobaDona, JA .
CLINICAL INFECTIOUS DISEASES, 1997, 24 (06) :1052-1059
[6]   QUANTITATIVE CULTURE OF INTRAVENOUS CATHETERS AND OTHER INTRAVASCULAR INSERTS [J].
CLERI, DJ ;
CORRADO, ML ;
SELIGMAN, SJ .
JOURNAL OF INFECTIOUS DISEASES, 1980, 141 (06) :781-787
[7]  
CRAVEN D E, 1992, Intensive Care Medicine, V18, pS3, DOI 10.1007/BF01752970
[8]   PREVENTING NOSOCOMIAL PNEUMONIA - STATE-OF-THE-ART AND PERSPECTIVES FOR THE 1990S [J].
CRAVEN, DE ;
STEGER, KA ;
BARBER, TW .
AMERICAN JOURNAL OF MEDICINE, 1991, 91 :S44-S53
[9]   NOSOCOMIAL INFECTION AND FATALITY IN MEDICAL AND SURGICAL INTENSIVE-CARE UNIT PATIENTS [J].
CRAVEN, DE ;
KUNCHES, LM ;
LICHTENBERG, DA ;
KOLLISCH, NR ;
BARRY, MA ;
HEEREN, TC ;
MCCABE, WR .
ARCHIVES OF INTERNAL MEDICINE, 1988, 148 (05) :1161-1168
[10]   Nosocomial pneumonia and mortality among patients in intensive care units [J].
Fagon, JY ;
Chastre, J ;
Vuagnat, A ;
Trouillet, JL ;
Novara, A ;
Gibert, C .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (11) :866-869