获得性多重耐药菌感染与呼吸机相关肺炎关联性的巢式病例对照研究

Multivariate analysis on the association between acquired multi-drug resistant organism infection and ventilator-associated pneumonia： evidence from a nested case-control study of eight ICUs

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.

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＆#39; s safety at the hospital.