感染肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌的重症肺炎患者的抗生素耐药性相关因素和存活率分析:印度尼西亚雅加达的一项回顾性队列研究。

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
SAGE Open Medicine Pub Date : 2024-08-27 eCollection Date: 2024-01-01 DOI:10.1177/20503121241264097
Gurmeet Singh, Tonny Loho, Mira Yulianti, Dita Aditianingsih, Laila Fakhriyatuz Zakiyah, Sudirman Fakhruddin Masse, Muhammad Rizki Triono
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引用次数: 0

摘要

背景:抗菌药耐药性是全球公共卫生面临的最大挑战之一,而重症肺炎的风险因素在不断增加。因此,本研究旨在确定与抗菌药耐药性相关的因素,并对印度尼西亚雅加达国立转诊医院的单病原体和多病原体重症肺炎患者进行生存分析:采用回顾性方法,从2016年1月至2022年12月印度尼西亚雅加达Cipto Mangunkusumo国立转诊医院重症监护室收治的重症肺炎患者中收集二手数据。呼吸道标本通过支气管冲洗采集。此外,还进行了单变量和多变量分析,以分析与抗菌药耐药性相关的因素。利用对数秩检验生成卡普兰-梅耶生存曲线,比较感染单一病原体、双重病原体和多重病原体患者的30天死亡率:结果显示,共对 415 名登记患者中的 333 名患者进行了分析。肺炎克雷伯菌(35.4%)、鲍曼不动杆菌(29.3%)和铜绿假单胞菌(15.4%)是最常见的革兰氏阴性病原体。对氨基糖苷类、碳青霉烯类和喹诺酮类药物产生耐药性的相关因素是败血症、脑血管疾病和呼吸机相关性肺炎:败血症、脑血管疾病和呼吸机相关肺炎与重症肺炎患者的抗菌药物耐药性有关。感染多种病原体的患者存活率较低。这表明,进一步提高对重症肺炎患者经验性抗生素管理和死亡率评估的认识非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors associated with antibiotic resistance and survival analysis of severe pneumonia patients infected with Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa: A retrospective cohort study in Jakarta, Indonesia.

Background: Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.

Methods: A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.

Results: The results showed that a total of 333 patients from 415 enrolled were analyzed. Klebsiella pneumoniae (35.4%), Acinetobacter baumannii (29.3%), and Pseudomonas aeruginosa (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by p < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (p < 0.05).

Conclusions: Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.

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SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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