呼吸道念珠菌定植与细菌性呼吸机相关性肺炎相关性研究

Study on the relationship between respiratory colonization of Candida spp. and bacterial ventilator?associated pneumonia

目的 探讨呼吸道念珠菌定植与细菌性呼吸机相关性肺炎（VAP）的相关性。方法 回顾性分析南方医科大学南方医院重症监护病房（ICU）2009年3月至2015年2月机械通气（MV）超过48 h的618例免疫功能正常患者的临床特征。按照诊断标准分为细菌性VAP组285例和对照组333例,应用单因素分析和Logistic回归分析探讨细菌性VAP的危险因素以及呼吸道念珠菌定植与细菌性VAP的相关性。结果 细菌性VAP发病率为46.12%。单因素分析显示两组入院时呼吸衰竭（P=0.010）、因呼吸衰竭入ICU（P=0.011）、中心静脉置管（P=0.007）、MV≥7 d（P〈0.001）和呼吸道念珠菌定植（P〈0.001）差异有统计学意义。Logistic回归分析结果显示,中心静脉置管（OR 2.274,95%CI 1.146-4.509）、呼吸道念珠菌定植（OR 2.107,95%CI 1.466-3.028）和MV≥7 d（OR 5.918,95%CI 4.004-8.747）是细菌性VAP的独立危险因素。结论 呼吸道念珠菌定植是细菌性VAP的独立危险因素,呼吸道念珠菌定植可增加MV患者发生细菌性VAP的风险。

Objective To explore the relationship between respiratory colonization of Candida spp. and bacterial ventilator-associated pneumonia（VAP）. Methods Clinical characteristics of 618 immunocompetent patients who received mechanical ventilation for 48 h at Nanfang Hospital of Southern Medical University between March 2009 and February 201S were retrospectively analysed. The selected patients were divided into bacterial VAP group and control group, 285 and 333 cases, respectively. Risk factors of bacterial VAP were identified by both univariate and multivariate analysis. Relationship between respiratory colonization of Candida spp. and bacterial VAP was explored. Results The overall incidence of bacterial VAP was 46.12%.Univariate analysis showed that respiratory failure at admission（P=0.010）, respiratory failure at ICU admission（P=0.011）, central venous catheterization（eVC） （P=0.007）, MV≥7 days（P〈0.001） and respiratory colonization of Candida spp （P〈0.001）. They were significantly associated with higher risk of respiratory tract colonization of Candida spp. Binary logistic regression suggested that CVC（OR=2.274, 95%CI 1.146-4.509）, respiratory colonization of Candida spp.（OR=2.107, 95%CI 1.466-3.028） and biV≥7 days（OR=5.918, 95%CI 4.004-8.747） were independent risk factors of respiratory tract colonization of Candida spp. Conclusion Respiratory colonization of Candida spp. is the independent risk factor of bacterial VAP and increases the risk of developing bacterial VAP in patients receiving MV.