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논문 기본 정보

자료유형
학술저널
저자정보
Chang Youjin (Division of Pulmonary and Critical Care Medicine Department of Internal Medicine College of Medicin) Jeon Kyeongman (Division of Pulmonary and Critical Care Medicine Department of Medicine Samsung Medical Center Sung) Lee Sang-Min (Division of Pulmonary and Critical Care Medicine Department of Internal Medicine Seoul National Uni) Cho Young-Jae (Division of Pulmonary and Critical Care Medicine Department of Internal Medicine Seoul National Uni) Kim Young Sam (Division of Pulmonology Department of Internal Medicine Severance Hospital Yonsei University Colleg) Chong Yong Pil (Department of Infectious Diseases Asan Medical Center University of Ulsan College of Medicine Seoul) Hong Sang-Bum (Department of Pulmonary and Critical Care Medicine Asan Medical Center University of Ulsan College)
저널정보
대한의학회 Journal of Korean Medical Science Journal of Korean Medical Science Vol.36 No.41
발행연도
2021.10
수록면
1 - 15 (15page)
DOI
10.3346/jkms.2021.36.e251

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Background: It is essential to determine the distribution of the causative microorganisms in the region and the status of local antibiotic resistance for the proper treatment of hospitalacquired pneumonia/ventilator-associated pneumonia (HAP/VAP). This study aimed to investigate the occurrence and causative strains of HAP/VAP, distribution of resistant bacteria, use of antibiotics, and the ensuing outcomes of patients in Korea. Methods: A multicenter prospective observational cohort study was conducted among patients with HAP/VAP admitted to the medical intensive care unit of 5 tertiary referral centers between August 2012 and June 2015. Patients' demographic and clinical data were collected. Results: A total of 381 patients were diagnosed with HAP/VAP. Their median age was 69 (59?76) years and 71% were males. A majority of the patients (88%) had late-onset (> 5 days) HAP/VAP. One-quarter of the patients (n = 99) had at least one risk factor for multidrug-resistant (MDR) pathogens, such as prior intravenous antibiotic use within the last 90 days. Microbiological specimens were mostly obtained noninvasively (87%) using sputum or endotracheal aspirates. Pathogens were identified in 235 (62%) of the 381 patients. The most common bacterial pathogen was Acinetobacter baumannii (n = 89), followed by Staphylococcus aureus (n = 52), Klebsiella pneumoniae (n = 25) and Pseudomonas aeruginosa (n = 22). Most of isolated A. baumannii (97%) and S. aureus (88%) were multidrug resistant. The most commonly used empirical antibiotic regimens were carbapenem-based antibiotics (38%), followed by extended-spectrum penicillin/ β-lactamase inhibitor (34%). Glycopeptide or linezolid were also used in combination in 54% of patients. The 28-day mortality rate of the patients with HAP/VAP was 30% and the 60-day mortality was 46%. Patients who used empirical antibiotics appropriately had significantly lower mortality rates than those who did not (28-day mortality: 25% vs. 40%, P = 0.032; 60- day mortality: 41% vs. 55%, P = 0.032, respectively). Administration of appropriate empirical antibiotics (odds ratio [OR], 0.282; confidence interval [CI], 0.092?0.859; P = 0.026), Day 7 treatment failure (OR, 4.515; CI, 1.545?13.192; P = 0.006), and APACHE II score on day 1 (OR, 1.326; CI, 0.988?1.779; P = 0.012) were the factors that determined the 28-day mortality in patients with HAP who had identified bacteria as pathogens. Conclusion: In HAP/VAP patients, there was a large burden of MDR pathogens, and their associated mortality rate was high. Proper selection of empirical antibiotics was significantly associated with the patient's prognosis; however, there was a discrepancy between major pathogens and empirical antibiotic therapy.
#Healthcare-associated Pneumonia #Ventilator-associated Pneumonia #Drug Resistance #Bacterial #Intensive Care Units #Treatment Outcome

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참고문헌 (25)

참고문헌 신청
American Thoracic Society; Infectious Diseases Society of America / 2005 / Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia / Am J Respir Crit Care Med 171(4):388~416 google schola Falagas ME / 2006 / Attributable mortality of Acinetobacter baumannii infections in critically ill patients : a systematic review of matched cohort and case-control studies / Crit Care 10(2):R48 google schola Agrafiotis M / 2011 / Attributable mortality of ventilator-associated pneumonia : a meta-analysis / Int J Tuberc Lung Dis 15(9):1154~1163 google schola Magill SS / 2014 / Multistate point-prevalence survey of health care-associated infections / N Engl J Med 370(13):1198~1208 google schola Zilberberg MD / 2019 / A novel algorithm to analyze epidemiology and outcomes of carbapenem resistance among patients with hospital-acquired and ventilator-associated pneumonia : a retrospective cohort study / Chest 155(6):1119~1130 google schola

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