Yi Huang1, Yang Jiao2, Jing Zhang3, Jinfu Xu4, Qijian Cheng5, Yi Li6, Shuo Liang3, Huayin Li2, Jin Gong6, Yinggang Zhu6, Lin Song7, Zhaohui Rong8, Bin Liu9, Zhijun Jie10, Shuo Sun11, Ping Li12, Guifang Wang13, Jieming Qu4. 1. Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Naval Medical University. 2. Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Fudan University, Shanghai Medical College. 3. Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital of Tongji University. 4. Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University. 5. Hongkou Branch, Shanghai Changhai Hospital, Naval Medical University. 6. Department of Respiratory Medicine, Huadong Hospital of Fudan University. 7. Department of Respiratory Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University. 8. Department of Respiratory Medicine, Sixth People's Hospital of Shanghai Jiaotong University. 9. Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University. 10. Department of Respiratory Medicine, Fifth People's Hospital of Fudan University. 11. Department of Respiratory Medicine, Longhua Hospital of Shanghai University of Traditional Chinese Medicine. 12. Department of Respiratory Medicine, Tenth People's Hospital of Tongji University. 13. Department of Respiratory Medicine, Huashan Hospital of Fudan University, Shanghai Medical College, People's Republic of China.
Abstract
Background: The microbial etiology and mortality risk factors of ventilator-associated pneumonia (VAP) have not been investigated extensively in Shanghai. Methods: VAP cases were identified from the patients hospitalized during the period from 1 January 2013 to 30 December 2017 in Shanghai. The relevant data were reviewed and analyzed retrospectively. Results: One hundred ninety-four VAP cases were included in this analysis. The overall mortality rate was 32.47%. The respiratory pathogens isolated from these patients included 212 bacterial strains and 54 fungal strains. The leading pathogens were Acinetobacter baumannii (33.96%), Klebsiella pneumoniae (23.58%), Pseudomonas aeruginosa (19.81%), and Staphylococcus aureus (7.08%). Candida colonization was associated with higher mortality of VAP patients compared to those without Candida colonization (45.45% vs 28.67%, P < .05). The VAP patients with Candida colonization also showed higher prevalence of P. aeruginosa, carbapenem-resistant P. aeruginosa (CRPA), K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), A. baumannii, and carbapenem-resistant A. baumannii (CRAB) (P < .05). VAP nonsurvivors had higher prevalence of CRPA, K. pneumoniae, CRAB, and Candida than VAP survivors (P < .05). Multivariate analysis showed that prior antibiotic use was a significant risk factor for Candida colonization, while hypertension and length of hospital stay were significant risk factors of VAP mortality (P < .05). Conclusions: The top pathogens of VAP patients in Shanghai tertiary teaching hospitals are A. baumannii, K. pneumoniae, and P. aeruginosa, with high prevalence of carbapenem resistance. Carbapenem-resistant bacterial pathogens and Candida may predict poor outcome.
Background: The microbial etiology and mortality risk factors of ventilator-associated pneumonia (VAP) have not been investigated extensively in Shanghai. Methods: VAP cases were identified from the patients hospitalized during the period from 1 January 2013 to 30 December 2017 in Shanghai. The relevant data were reviewed and analyzed retrospectively. Results: One hundred ninety-four VAP cases were included in this analysis. The overall mortality rate was 32.47%. The respiratory pathogens isolated from these patients included 212 bacterial strains and 54 fungal strains. The leading pathogens were Acinetobacter baumannii (33.96%), Klebsiella pneumoniae (23.58%), Pseudomonas aeruginosa (19.81%), and Staphylococcus aureus (7.08%). Candida colonization was associated with higher mortality of VAP patients compared to those without Candida colonization (45.45% vs 28.67%, P < .05). The VAP patients with Candida colonization also showed higher prevalence of P. aeruginosa, carbapenem-resistant P. aeruginosa (CRPA), K. pneumoniae, carbapenem-resistant K. pneumoniae (CRKP), A. baumannii, and carbapenem-resistant A. baumannii (CRAB) (P < .05). VAP nonsurvivors had higher prevalence of CRPA, K. pneumoniae, CRAB, and Candida than VAP survivors (P < .05). Multivariate analysis showed that prior antibiotic use was a significant risk factor for Candida colonization, while hypertension and length of hospital stay were significant risk factors of VAP mortality (P < .05). Conclusions: The top pathogens of VAP patients in Shanghai tertiary teaching hospitals are A. baumannii, K. pneumoniae, and P. aeruginosa, with high prevalence of carbapenem resistance. Carbapenem-resistant bacterial pathogens and Candida may predict poor outcome.
Authors: Juan Carlos de Rivero Vaccari; W Dalton Dietrich; Robert W Keane; Juan Pablo de Rivero Vaccari Journal: Front Immunol Date: 2020-10-08 Impact factor: 7.561