Comparison and analysis of mortality and risk factors of ventilator-associated pneumonia with carbapenem-resistant and non-carbapenem-resistant gram-negative bacteria in China_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

RAN Keke , WANG Jiali ,  YE Huan

Department of Respiratory and Critical Care Medicine, Beijing Chest Hospital, Capital Medical University, Beijing 101149, P. R. China;

Corresponding?author：

YE Huan, Email: yedahuan@yeah.net

Keywords：

Carbapenem-resistant gram-negative bacteria; ventilator-associated pneumonia; mortality; risk factor

DOI：

10.7507/1671-6205.202303078

Video：

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Objective A comparative study of in-hospital mortality and risk factors of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB) and non-carbapenem-resistant gram-negative bacteria (nCRGNB) in China was conducted to investigate whether there is a higher in-hospital mortality of VAP caused by CRGNB and its unique associated risk factors. Methods Relevant literatures published at home and abroad in PubMed, EMBASE, Cochrane library, Web of Science, CNKI and Wanfang databases were retrieved from the date of establishment to June 1, 2021, and the quality of the included literatures was evaluated using Newcastle-Ottawa scale. Meta-analysis of literatures meeting the criteria was performed using RevMan 5.3 software. Results A total of 5 literatures were included, all of which were case-control studies with a total of 574 cases, including 302 cases in the CRGNB group and 272 cases in the nCRGNB group. The results showed that the in-patient mortality of VAP caused by CRGNB infection was significantly increased compared with that of VAP caused by nCRGNB infection (OR=2.51, 95%CI 1.71 - 3.67, P<0.00001). Risk factor analysis of CRGNB infection showed that statistically significant risk factors included mechanical ventilation duration ≥7 days (OR=2.66, 95%CI 1.23 - 5.75, P=0.01), secondary intubation (OR=4.48, 95%CI 2.61 - 7.69], P<0.00001), combined with antibiotics (OR=2.83, 95%CI 1.76 - 4.54, P<0.0001), using carbapenem antibiotics (OR=2.78, 95%CI 1.76 - 4.40, P<0.0001). In addition, two studies showed that tigecycline was sensitive to CRGNB in vitro. Conclusions Compared with nCRGNB-induced VAP, CRGNB infection significantly increases the in-hospital mortality of VAP patients in China, indicating that the in-hospital mortality of CRGNB infection is related to drug resistance, and had little relationship with region and drug resistance mechanism. Among them, mechanical ventilation duration ≥7 days, secondary intubation, combined use of antibiotics and carbapenem antibiotics are risk factors for CRGNB infection in VAP patients. Tigecycline is sensitive to most CRGNB strains in China and is an important choice for the treatment of CRGNB in China.

Citation： RAN Keke, WANG Jiali, YE Huan. Comparison and analysis of mortality and risk factors of ventilator-associated pneumonia with carbapenem-resistant and non-carbapenem-resistant gram-negative bacteria in China. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(12): 852-857. doi: 10.7507/1671-6205.202303078 Copy

1.	Mohamed A, Daef E, Nafie A, et al. Characteristics of carbapenem-resistant gram-negative bacilli in patients with ventilator-associated pneumonia. Antibiotics (Basel), 2021, 10(11): 1325.
2.	Grundmann H, Livermore DM, Giske CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill, 2010, 15(46): 19711.
3.	Timsit JF, Esaied W, Neuville M, et al. Update on ventilator-associated pneumonia. F1000Res, 2017, 6: 2061.
4.	Zilberberg MD, Nathanson BH, Sulham K, et al. 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, 2019, 155(6): 1119-1130.
5.	崔穎鵬, 馮冰, 彭雅琴, 等. 耐碳青霉烯藥鮑曼不動桿菌耐藥性及相關耐藥基因研究. 實用醫學雜志, 2021, 37(19): 2513-2517.
6.	中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
7.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
8.	劉周, 儲雯雯, 李昕, 等. VAP患者下呼吸道分離CRKP的臨床及分子生物學流行特征. 中國感染控制雜志, 2021, 20(5): 403-409.
9.	劉銀梅, 吳曉松, 楊惠英, 等. 耐碳青霉烯類肺炎克雷伯菌呼吸機相關肺炎發病及預后危險因素. 中華醫院感染學雜志, 2020, 30(22): 3378-3383.
10.	費東生, 曹延會, 南川川, 等. 耐碳青霉烯類抗生素肺炎克雷伯菌呼吸機相關性肺炎的危險因素. 中國老年學雜志, 2014, 34(21): 5973-5976.
11.	彭立悅, 孫建萍, 張京嵐. 呼吸機相關性肺炎病原學及感染耐碳青霉烯類革蘭陰性菌危險因素與預后分析. 心肺血管病雜志, 2017, 36(9): 721-727.
12.	Chang HC, Chen YC, Lin MC, et al. Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia. J Formos Med Assoc, 2011, 110(9): 564-571.
13.	高歡, 田杰, 方俊君, 等. ICU患者感染CRKP與CSKP的耐藥基因和毒力基因. 中華醫院感染學雜志, 2022, 32(11): 1606-1610.
14.	Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious diseases society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
15.	任建偉, 武元星, 劉玉磊, 等. 呼吸與危重癥醫學科革蘭陰性桿菌感染的臨床特征與耐藥現狀: 2018年—2021年的回顧性研究. 中國呼吸與危重監護雜志, 2022, 21(12): 867-872.
16.	Findlay J, Hamouda A, Dancer SJ, et al. Rapid acquisition of decreased carbapenem susceptibility in a strain of Klebsiella pneumoniae arising during meropenem therapy. Clin Microbiol Infec, 2012, 18(2): 140-146.
17.	Villar HE, Santana G, Jugo MB, et al. In vitro emergence of carbapenem resistance in extended-spectrum β-lactamase-producing Klebsiella pneumoniae clinical isolates. J Infect Dev Ctries, 2015, 9(2): 218-221.
18.	Hussein K, Sprecher H, Mashiach T, et al. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol, 2009, 30(7): 666-671.
19.	郝東俠, 王偉, 劉偉, 等. 綜合ICU內耐碳青霉烯鮑曼不動桿菌相關呼吸機相關性肺炎的危險因素分析. 中國臨床醫生雜志, 2017, 45(12): 29-31.
20.	Shojaei L, Mohammadi M, Beigmohammadi MT, et al. Clinical response and outcome of pneumonia due to multi-drug resistant Acinetobacter baumannii in critically ill patients. Iran J Microbiol, 2016, 8(5): 288-297.

1. Mohamed A, Daef E, Nafie A, et al. Characteristics of carbapenem-resistant gram-negative bacilli in patients with ventilator-associated pneumonia. Antibiotics (Basel), 2021, 10(11): 1325.
2. Grundmann H, Livermore DM, Giske CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill, 2010, 15(46): 19711.
3. Timsit JF, Esaied W, Neuville M, et al. Update on ventilator-associated pneumonia. F1000Res, 2017, 6: 2061.
4. Zilberberg MD, Nathanson BH, Sulham K, et al. 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, 2019, 155(6): 1119-1130.
5. 崔穎鵬, 馮冰, 彭雅琴, 等. 耐碳青霉烯藥鮑曼不動桿菌耐藥性及相關耐藥基因研究. 實用醫學雜志, 2021, 37(19): 2513-2517.
6. 中華醫學會呼吸病學分會感染學組. 中國成人醫院獲得性肺炎與呼吸機相關性肺炎診斷和治療指南(2018年版). 中華結核和呼吸雜志, 2018, 41(4): 255-280.
7. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
8. 劉周, 儲雯雯, 李昕, 等. VAP患者下呼吸道分離CRKP的臨床及分子生物學流行特征. 中國感染控制雜志, 2021, 20(5): 403-409.
9. 劉銀梅, 吳曉松, 楊惠英, 等. 耐碳青霉烯類肺炎克雷伯菌呼吸機相關肺炎發病及預后危險因素. 中華醫院感染學雜志, 2020, 30(22): 3378-3383.
10. 費東生, 曹延會, 南川川, 等. 耐碳青霉烯類抗生素肺炎克雷伯菌呼吸機相關性肺炎的危險因素. 中國老年學雜志, 2014, 34(21): 5973-5976.
11. 彭立悅, 孫建萍, 張京嵐. 呼吸機相關性肺炎病原學及感染耐碳青霉烯類革蘭陰性菌危險因素與預后分析. 心肺血管病雜志, 2017, 36(9): 721-727.
12. Chang HC, Chen YC, Lin MC, et al. Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia. J Formos Med Assoc, 2011, 110(9): 564-571.
13. 高歡, 田杰, 方俊君, 等. ICU患者感染CRKP與CSKP的耐藥基因和毒力基因. 中華醫院感染學雜志, 2022, 32(11): 1606-1610.
14. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious diseases society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
15. 任建偉, 武元星, 劉玉磊, 等. 呼吸與危重癥醫學科革蘭陰性桿菌感染的臨床特征與耐藥現狀: 2018年—2021年的回顧性研究. 中國呼吸與危重監護雜志, 2022, 21(12): 867-872.
16. Findlay J, Hamouda A, Dancer SJ, et al. Rapid acquisition of decreased carbapenem susceptibility in a strain of Klebsiella pneumoniae arising during meropenem therapy. Clin Microbiol Infec, 2012, 18(2): 140-146.
17. Villar HE, Santana G, Jugo MB, et al. In vitro emergence of carbapenem resistance in extended-spectrum β-lactamase-producing Klebsiella pneumoniae clinical isolates. J Infect Dev Ctries, 2015, 9(2): 218-221.
18. Hussein K, Sprecher H, Mashiach T, et al. Carbapenem resistance among Klebsiella pneumoniae isolates: risk factors, molecular characteristics, and susceptibility patterns. Infect Control Hosp Epidemiol, 2009, 30(7): 666-671.
19. 郝東俠, 王偉, 劉偉, 等. 綜合ICU內耐碳青霉烯鮑曼不動桿菌相關呼吸機相關性肺炎的危險因素分析. 中國臨床醫生雜志, 2017, 45(12): 29-31.
20. Shojaei L, Mohammadi M, Beigmohammadi MT, et al. Clinical response and outcome of pneumonia due to multi-drug resistant Acinetobacter baumannii in critically ill patients. Iran J Microbiol, 2016, 8(5): 288-297.

Chinese Journal of Respiratory and Critical Care Medicine

Comparison and analysis of mortality and risk factors of ventilator-associated pneumonia with carbapenem-resistant and non-carbapenem-resistant gram-negative bacteria in China

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