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.	崔颖鹏, 冯冰, 彭雅琴, 等. 耐碳青霉烯药鲍曼不动杆菌耐药性及相关耐药基因研究. 实用医学杂志, 2021, 37(19): 2513-2517.
6.	中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 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.	刘周, 储雯雯, 李昕, 等. VAP患者下呼吸道分离CRKP的临床及分子生物学流行特征. 中国感染控制杂志, 2021, 20(5): 403-409.
9.	刘银梅, 吴晓松, 杨惠英, 等. 耐碳青霉烯类肺炎克雷伯菌呼吸机相关肺炎发病及预后危险因素. 中华医院感染学杂志, 2020, 30(22): 3378-3383.
10.	费东生, 曹延会, 南川川, 等. 耐碳青霉烯类抗生素肺炎克雷伯菌呼吸机相关性肺炎的危险因素. 中国老年学杂志, 2014, 34(21): 5973-5976.
11.	彭立悦, 孙建萍, 张京岚. 呼吸机相关性肺炎病原学及感染耐碳青霉烯类革兰阴性菌危险因素与预后分析. 心肺血管病杂志, 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.	高欢, 田杰, 方俊君, 等. ICU患者感染CRKP与CSKP的耐药基因和毒力基因. 中华医院感染学杂志, 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.	任建伟, 武元星, 刘玉磊, 等. 呼吸与危重症医学科革兰阴性杆菌感染的临床特征与耐药现状: 2018年—2021年的回顾性研究. 中国呼吸与危重监护杂志, 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.	郝东侠, 王伟, 刘伟, 等. 综合ICU内耐碳青霉烯鲍曼不动杆菌相关呼吸机相关性肺炎的危险因素分析. 中国临床医生杂志, 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. 崔颖鹏, 冯冰, 彭雅琴, 等. 耐碳青霉烯药鲍曼不动杆菌耐药性及相关耐药基因研究. 实用医学杂志, 2021, 37(19): 2513-2517.
6. 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版). 中华结核和呼吸杂志, 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. 刘周, 储雯雯, 李昕, 等. VAP患者下呼吸道分离CRKP的临床及分子生物学流行特征. 中国感染控制杂志, 2021, 20(5): 403-409.
9. 刘银梅, 吴晓松, 杨惠英, 等. 耐碳青霉烯类肺炎克雷伯菌呼吸机相关肺炎发病及预后危险因素. 中华医院感染学杂志, 2020, 30(22): 3378-3383.
10. 费东生, 曹延会, 南川川, 等. 耐碳青霉烯类抗生素肺炎克雷伯菌呼吸机相关性肺炎的危险因素. 中国老年学杂志, 2014, 34(21): 5973-5976.
11. 彭立悦, 孙建萍, 张京岚. 呼吸机相关性肺炎病原学及感染耐碳青霉烯类革兰阴性菌危险因素与预后分析. 心肺血管病杂志, 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. 高欢, 田杰, 方俊君, 等. ICU患者感染CRKP与CSKP的耐药基因和毒力基因. 中华医院感染学杂志, 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. 任建伟, 武元星, 刘玉磊, 等. 呼吸与危重症医学科革兰阴性杆菌感染的临床特征与耐药现状: 2018年—2021年的回顾性研究. 中国呼吸与危重监护杂志, 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. 郝东侠, 王伟, 刘伟, 等. 综合ICU内耐碳青霉烯鲍曼不动杆菌相关呼吸机相关性肺炎的危险因素分析. 中国临床医生杂志, 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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