The Contribution of Carbapenem-Resistant Pseudomonas Aeruginosa Isolation to Clinical Outcomes in Hospitalized Patients with Exacerbations of Bronchiectasis: A Retrospective Cohort Study.

IF 4.6 2区医学 Q1 RESPIRATORY SYSTEM Lung Pub Date : 2025-01-03 DOI:10.1007/s00408-024-00770-7

Jibo Sun, Xiang Tong, Xiu Li, Lian Wang, Dongguang Wang, Qingqing Jia, Shijie Zhang, Sitong Liu, Wenting Lv, Ye Wang, Hong Fan

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Abstract

Background: The antibiotic resistance of Pseudomonas aeruginosa (PA) is increasingly severe in bronchiectasis patients. However, there is currently a lack of research on the clinical outcomes of carbapenem-resistant PA (CRPA) isolation in hospitalized exacerbations of bronchiectasis (HEB) patients. We investigated the incidence, risk factors, and clinical outcomes of PA and CRPA isolation in HEB patients.

Methods: This was an observational, retrospective cohort study of PA and CRPA isolated from sputum or bronchoalveolar lavage fluid cultures of HEB patients from January 1, 2018 to December 31, 2022. The primary outcomes were respiratory failure, mechanical ventilation, and length of hospital stay. The incidence, risk factors, and clinical outcomes of PA and CRPA isolation were analyzed using multivariate logistic and Poisson regression.

Results: Among 1,286 patients, the prevalence of PA, CRPA, and multi-drug resistant PA isolation was 20.61% (n = 265), 3.81% (n = 49), and 5.83% (n = 75), respectively. CRPA isolation was associated with an increased risk for respiratory failure (adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI) [1.29, 5.11]; p = 0.007), mechanical ventilation (aOR 3.65; 95% CI [1.50, 8.92]; p = 0.004), and length of hospital stay (Coefficient (Coef) 0.27; 95% CI [0.18,0.35]; p < 0.001) compared to non-CRPA. Antibiotic treatment decreased the risk of respiratory failure (aOR 0.37; 95% CI [0.17, 0.80]; p = 0.011), mechanical ventilation (aOR 0.36; 95% CI [0.13, 0.99]; p = 0.047), and length of hospital stay (Coef - 0.23; 95% CI [- 0.33, - 0.14]; p < 0.001).

Conclusions: CRPA isolation was identified in more severe bronchiectasis patients and significantly increased the risk of respiratory failure, mechanical ventilation and length of hospital stay, while antibiotic treatment reduced this risk.

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碳青霉烯耐药铜绿假单胞菌分离对支气管扩张急性加重住院患者临床结局的影响：一项回顾性队列研究

背景：铜绿假单胞菌（Pseudomonas aeruginosa， PA）耐药性在支气管扩张患者中日益严重。然而，目前缺乏碳青霉烯耐药PA （CRPA）分离治疗支气管扩张（HEB）住院加重患者的临床结果的研究。我们调查了HEB患者中PA和CRPA分离的发生率、危险因素和临床结果。方法：对2018年1月1日至2022年12月31日HEB患者痰液或支气管肺泡灌洗液培养物中分离的PA和CRPA进行观察性、回顾性队列研究。主要结局为呼吸衰竭、机械通气和住院时间。采用多因素logistic回归和泊松回归分析PA和CRPA分离的发病率、危险因素和临床结局。结果：1286例患者中，PA、CRPA和多重耐药PA分离的患病率分别为20.61% （n = 265）、3.81% （n = 49）和5.83% （n = 75）。分离CRPA与呼吸衰竭风险增加相关(调整优势比（aOR） 2.56；95%置信区间（CI） [1.29, 5.11]；p = 0.007)、机械通气(aOR 3.65；95% ci [1.50, 8.92]；p = 0.004)、住院时间(系数（Coef） 0.27；95% ci [0.18,0.35]；结论：在更严重的支气管扩张患者中发现了CRPA隔离，并显著增加了呼吸衰竭、机械通气和住院时间的风险，而抗生素治疗降低了这一风险。

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来源期刊

Lung 医学-呼吸系统

CiteScore

9.10

自引率

10.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.