Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in...Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3% or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95% confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95% CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.展开更多
Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in ...Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6~0 （n = 95） in patients who required more than 48 h of mechanical ventilation. Staphylococcus （37.7%）, Enterobacteriaceae （32.1%）, Pseudomonas （20.8%）, and Haemophilus （16.9~） were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively （P = 0.006）. Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively （P 〈 0.001）. The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.展开更多
Background Ventilator-associated pneumonia(VAP)is a significant and common health concern.The epidemiological landscape of VAP is poorly understood in neurosurgery patients.This study aimed to explore the epidemiology...Background Ventilator-associated pneumonia(VAP)is a significant and common health concern.The epidemiological landscape of VAP is poorly understood in neurosurgery patients.This study aimed to explore the epidemiology of VAP in this population and devise targeted surveillance,treatment,and control efforts.Methods A 10-year retrospective study spanning 2011 to 2020 was performed in a large Chinese tertiary hospital.Surveillance data was collected from neurosurgical patients and analyzed to map the demographic and clinical characteristics of VAP and describe the distribution and antimicrobial resistance profile of leading pathogens.Risk factors associated with the presence of VAP were explored using boosted regression tree(BRT)models.Results Three hundred ten VAP patients were identified.The 10-year incidence of VAP was 16.21 per 1000 ventilation days.All-cause mortality was 6.1%.The prevalence of gram-negative bacteria,fungi,and gram-positive bacteria among the 357 organisms isolated from VAP patients was 86.0%,7.6%,and 6.4%,respectively;most were multidrug-resistant organisms.Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa were the most common pathogens.The prevalence of carbapenem-resistant A.baumannii,P.aeruginosa,and K.pneumoniae was high and increased over time in the study period.The BRT models revealed that VAP was associated with number of days of ventilator use(relative contribution,47.84±7.25),Glasgow Coma Scale score(relative contribution,24.72±5.67),and tracheotomy(relative contribution,21.50±2.69).Conclusions Our findings provide a better understanding of the epidemiology of VAP and its risk factors in neurosurgery patients.展开更多
目的:探讨对呼吸机相关性肺炎(VAP)患儿实施基于前馈风险控制理论的精细化护理的临床价值。方法:病例选取开封市儿童医院2020年3月—2022年3月103例VAP患儿为研究对象,采用随机数字表法分为对照组(51例)与研究组(52例),研究组接受基于...目的:探讨对呼吸机相关性肺炎(VAP)患儿实施基于前馈风险控制理论的精细化护理的临床价值。方法:病例选取开封市儿童医院2020年3月—2022年3月103例VAP患儿为研究对象,采用随机数字表法分为对照组(51例)与研究组(52例),研究组接受基于前馈风险控制理论的精细化护理,对照组接受常规护理。比较两组的儿童状态-特质焦虑量表(STAIC)评分、血清降钙素原(PCT)、儿童抑郁评定量表(CDRS)评分、血清淀粉样蛋白(SAA)、临床症状改善时间及治疗依从性。结果:干预后研究组与对照组PCT(0.84±0.18 vs 1.21±0.22)ng/mL、STAIC(38.58±2.60 vs 35.26±3.58)分、SAA(7.26±0.22 vs 11.25±0.94)mg/L、CDRS(7.52±1.68 vs 15.48±2.17)分比较差异有统计学意义(P<0.05)。研究组与对照组咳嗽(3.74±0.51 vs 4.81±0.66)d、发热(1.50±0.37 vs 1.93±0.42)d、气促(2.08±0.70 vs 2.85±0.75)d、咳痰(3.51±0.64 vs 4.18±0.81)d改善时间比较差异有统计学意义(P<0.05),研究组与对照组治疗依从率(96.15%vs 80.39%)比较差异有统计学意义(P<0.05)。结论:基于循证理念的标准化护理可缩短支气管肺炎患儿身体康复时间,减轻患儿局部炎症反应,提高患儿治疗依从性。展开更多
文摘Background:Ventilator-associated pneumonia (VAP) in neonates has been associated with high mortality and poor outcome.This study aimed to compare the incidence,risk factors,and outcomes of VAP and nonVAP conditions in neonates.Methods:We performed a prospective cohort study in a neonatal intensive care unit (NICU) in Thailand from January 2014 to December 2014.All neonatal patients who were ventilated more than 48 hours were enrolled.Results:There were 128 enrolled patients.The median (inter quartile range) gestational age and birthweight were 35 (30.2,37.8) weeks and 2380 (1323.8,3020.0) g.There were 17 VAP patients (19 episodes) and 111 non-VAP ones.The VAP rate was 13.3% or 10.1 per 1000 ventilator days.According to the multivariate analysis,a birthweight less than 750 g [adjusted odds ratio (aOR)=10.75,95% confidence interval (CI)=2.35-49.16;P=0.002] and sedative medication use (aOR=4.00,95% CI=1.23-12.50;P=0.021)were independent risk factors for VAP.Compared with the non-VAP group,the median difference in the VAP group yielded a significantly longer duration of NICU stay (18 days,P=0.001),total length of hospital stay (16 days,P=0.002) and higher hospital costs ($5113,P=0.001).The inhospital mortality rate in the VAP and non-VAP groups was 17.6% and 15.3% (P=0.73),respectively.Conclusions:A neonatal birthweight less than 750 g and sedative medication use were independent risk factors for VAP.Our VAP patients experienced a longer duration of both NICU and hospital stay,and incurred higher hospitalization costs.
文摘Patients undergoing major oncological surgery for head and neck cancer （SHNC） have a particularly high risk of nosocomial infections. We aimed to identify risk factors for ventilator-associated pneumonia （VAP） in patients undergoing SHNC. The study included 465 patients who underwent SHNC between June 2011 and June 2014. The rate of VAP, risk factors for VAP, and biological aspects of VAP were retrospectively evaluated. The incidence of VAP was 19.6~0 （n = 95） in patients who required more than 48 h of mechanical ventilation. Staphylococcus （37.7%）, Enterobacteriaceae （32.1%）, Pseudomonas （20.8%）, and Haemophilus （16.9~） were the major bacterial species that caused VAP. The independent risk factors for VAP were advanced age, current smoking status, chronic obstructive pulmonary disease, and a higher simplified acute physiology score system II upon admission. Tracheostomy was an independent protective factor for VAP. The median length of stay in the ICU for patients who did or did not develop VAP was 8.0 and 6.5 days, respectively （P = 0.006）. Mortality among patients who did or did not develop VAP was 16.8% and 8.4%, respectively （P 〈 0.001）. The potential economic impact of VAP was high because of the significantly extended duration of ventilation. A predictive regression model was developed with a sensitivity of 95.3% and a specificity of 69.4%. VAP is common in patients who are undergoing SHNC and who require more than 48 h of mechanical ventilation. Therefore, innovative preventive measures should be developed and applied in this high-risk population.
基金Youth-Support Project of Chinese PLA General Hospital(QNF19044)Project on Bio-Safety Control and Prevention(2020-YJXTGCWQS-X9288).
文摘Background Ventilator-associated pneumonia(VAP)is a significant and common health concern.The epidemiological landscape of VAP is poorly understood in neurosurgery patients.This study aimed to explore the epidemiology of VAP in this population and devise targeted surveillance,treatment,and control efforts.Methods A 10-year retrospective study spanning 2011 to 2020 was performed in a large Chinese tertiary hospital.Surveillance data was collected from neurosurgical patients and analyzed to map the demographic and clinical characteristics of VAP and describe the distribution and antimicrobial resistance profile of leading pathogens.Risk factors associated with the presence of VAP were explored using boosted regression tree(BRT)models.Results Three hundred ten VAP patients were identified.The 10-year incidence of VAP was 16.21 per 1000 ventilation days.All-cause mortality was 6.1%.The prevalence of gram-negative bacteria,fungi,and gram-positive bacteria among the 357 organisms isolated from VAP patients was 86.0%,7.6%,and 6.4%,respectively;most were multidrug-resistant organisms.Acinetobacter baumannii,Klebsiella pneumoniae,and Pseudomonas aeruginosa were the most common pathogens.The prevalence of carbapenem-resistant A.baumannii,P.aeruginosa,and K.pneumoniae was high and increased over time in the study period.The BRT models revealed that VAP was associated with number of days of ventilator use(relative contribution,47.84±7.25),Glasgow Coma Scale score(relative contribution,24.72±5.67),and tracheotomy(relative contribution,21.50±2.69).Conclusions Our findings provide a better understanding of the epidemiology of VAP and its risk factors in neurosurgery patients.
文摘目的:探讨对呼吸机相关性肺炎(VAP)患儿实施基于前馈风险控制理论的精细化护理的临床价值。方法:病例选取开封市儿童医院2020年3月—2022年3月103例VAP患儿为研究对象,采用随机数字表法分为对照组(51例)与研究组(52例),研究组接受基于前馈风险控制理论的精细化护理,对照组接受常规护理。比较两组的儿童状态-特质焦虑量表(STAIC)评分、血清降钙素原(PCT)、儿童抑郁评定量表(CDRS)评分、血清淀粉样蛋白(SAA)、临床症状改善时间及治疗依从性。结果:干预后研究组与对照组PCT(0.84±0.18 vs 1.21±0.22)ng/mL、STAIC(38.58±2.60 vs 35.26±3.58)分、SAA(7.26±0.22 vs 11.25±0.94)mg/L、CDRS(7.52±1.68 vs 15.48±2.17)分比较差异有统计学意义(P<0.05)。研究组与对照组咳嗽(3.74±0.51 vs 4.81±0.66)d、发热(1.50±0.37 vs 1.93±0.42)d、气促(2.08±0.70 vs 2.85±0.75)d、咳痰(3.51±0.64 vs 4.18±0.81)d改善时间比较差异有统计学意义(P<0.05),研究组与对照组治疗依从率(96.15%vs 80.39%)比较差异有统计学意义(P<0.05)。结论:基于循证理念的标准化护理可缩短支气管肺炎患儿身体康复时间,减轻患儿局部炎症反应,提高患儿治疗依从性。
