白念珠菌气道定植对铜绿假单胞菌所致呼吸机相关性肺炎的影响

doi:10.3969/j.issn.1006-7795.2024.02.003

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 187-193.doi: 10.3969/j.issn.1006-7795.2024.02.003

• 重症医学诊疗技术与进展 • 上一篇下一篇

白念珠菌气道定植对铜绿假单胞菌所致呼吸机相关性肺炎的影响

王丽辉¹, 张伟俊¹, 杨思敏², 朱琤³, 林彬⁴, 皋源¹, 向淑麟^5,6,7, 余跃天^1,4,5,8*

1.上海交通大学医学院附属仁济医院重症医学科，上海 200001；2.同济大学附属东方医院南院检验科，上海 200123；3.上海交通大学医学院附属瑞金医院预防保健科，上海 200025； 4.湖州市智能药学与个体化治疗重点实验室，浙江湖州 313100；5. 广西急性呼吸窘迫综合征诊治研究重点实验室，南宁 530021；6. 广西医学科学院传染病与急危重症救治研究所，南宁 530021； 7.广西壮族自治区人民医院重症医学科，南宁 530021；8.国家教育部多脏器衰竭预警与干预重点实验室，杭州 310027

收稿日期:2023-12-10 出版日期:2024-04-21 发布日期:2024-04-25
通讯作者: 余跃天 E-mail:fishyyt@sina.com
基金资助:
国家教育部多脏器衰竭预警与干预重点实验室开放基金 (226-2023-00100),湖州市智能药学与个体化治疗重点实验室开放基金 (HZKF-20240101),广西急性呼吸窘迫综合征诊治研究重点实验室开放基金（ZZH2020013）。

The impact of Candida albicans colonization in the airway on ventilator-associated pneumonia caused by Pseudomonas aeruginosa

Wang Lihui¹, Zhang Weijun¹, Yang Simin², Zhu Cheng³, Lin Bin⁴, Gao Yuan¹, Xiang Shulin^5,6,7, Yu Yuetian^1,4,5,8*

1. Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China； 2. Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China； 3. Department of Disease Prevention and Healthcare, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China； 4. Key Laboratory of Intelligent Pharmacy and Individualized Therapy, Zhejiang Huzhou 313100, China； 5. Guangxi Health Commission Key Laboratory of Diagnosis and Treatment of Acute Respiratory Distress Syndrome, Nanning 530021, China； 6. Research Center of Communicable and Severe Diseases, Guangxi Academy of Medical Sciences, Nanning 530021, China； 7. Department of Intensive Care Unit, The Peoples Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China； 8. Key Laboratory of Multiple Organ Failure（Zhejiang University），Ministry of Education, Hangzhou 310027, China

Received:2023-12-10 Online:2024-04-21 Published:2024-04-25
Supported by:
This study was supported by the Project of the Key Laboratory of Multiple Organ Failure, Ministry of Education (226-2023-00100), the Key Laboratory of Intelligent Pharmacy and Individualized Treatment in Huzhou City (HZKF-20240101), and the Guangxi Key Laboratory for Diagnosis and Treatment of Acute Respiratory Distress Syndrome (ZZH2020013).

摘要/Abstract

摘要： 目的探讨白念珠菌气道定植对多重耐药铜绿假单胞菌所致呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）患者病死率、抗菌药物疗程、免疫状态及炎症状态的影响。方法本前瞻性多中心队列研究以2018年6月至2023年6月收治于6所三级甲等综合教学医院重症医学科的多重耐药铜绿假单胞菌所致VAP患者为研究对象。根据患者呼吸道是否存在白念珠菌定植分为定植组及非定植组。比较两组患者30 d全因死亡率、抗菌药物敏感性及疗程、诊断VAP后第 1、3、5、7天免疫指标及炎症指标变化。结果 5年研究期间共纳入多重耐药铜绿假单胞菌导致VAP患者232例，其中白念珠菌定植组105例，非定植组127例。非定植组患者检出的铜绿假单胞菌对于氨基糖苷类、头孢菌素类及碳青霉烯类抗菌药物的敏感性均高于定植组（P<0.05），但两组患者对于16种抗菌药物的敏感性均低于中国细菌耐药监测网（China antimicrobial surveillance network, CHINET）2022年水平（P<0.05）。研究发现非定植组患者白介素-17A、（1,3）-β-D葡聚糖在各时间节点均低于定植组，且其他炎性指标更容易恢复至正常范围（P<0.05），同时非定植组患者的T 及Th 淋巴细胞绝对值可以在第7天更快地恢复至正常水平（P<0.05）。两组患者30 d全因死亡率差异无统计学意义（25.7% vs 22.8%，P=0.61），但非定植组抗菌药物的疗程明显短于定植组［（11.3±3.1)d vs （14.2±4.7)d，P<0.01）］，且存在重症医学科住院时间缩短的趋势。结论气道白念珠菌定植不影响多重耐药铜绿假单胞菌所致VAP患者的30 d全因死亡率，但会延长炎症反应及抗菌药物使用时间并导致免疫功能延迟恢复。

Abstract: Objective To investigate the impact of Candida albicans colonization on the mortality, duration of antibiotic therapy, immune and inflammation status in patients with ventilator-associated pneumonia (VAP) caused by multidrug-resistant Pseudomonas aeruginosa. Methods This prospective multicenter cohort study included patients with VAP caused by multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) admitted to six tertiary teaching hospitals from June 2018 to June 2023. The patients were divided into colonization group and non-colonization group based on the presence of Candida albicans detected in the broncho-alveolar lavage fluid (BALF). The 30-d all-cause mortality, duration of antibiotic therapy, immune and inflammation status were compared between the two groups after VAP diagnosis on the day1, day3, day5, and day7. Results During the five-year research period, a total of 232 VAP patients caused by MDR-Pa were included from six participating units in the intensive care unit (ICU), with 105 cases in the colonization group and 127 cases in the non-colonization group. The Pseudomonas aeruginosa detected in BALF samples from the non-colonization group showed higher sensitivity to aminoglycosides, cephalosporins, and carbapenems compared to the colonization group (P<0.05). However, both groups showed lower sensitivity to 16 antibiotics compared to China antimicrobial surveillance network (CHINET) 2022 (P<0.05). Interleukin-17A and (1,3)-β-D glucan levels in the non-colonization group were consistently lower than those in the colonization group at various time points, and other inflammatory markers were more likely to return to normal values (P<0.05). Additionally, the absolute values of T and Th lymphocytes in the non-colonization group recovered to normal levels faster on the day 7 (P<0.05). There was no statistically significant difference in the 30-d all-cause mortality between the two groups (25.7% vs 22.8%, P=0.61), but the non-colonization group had a significantly shorter duration of antibiotic therapy compared to the colonization group ［(11.3±3.1)d vs （14.2±4.7)d, P<0.01］, with a trend towards shorter ICU hospitalization time. Conclusion The colonization of Candida albicans in the airway does not affect the 30-d all-cause mortality of patients with VAP caused by MDR-Pa. However, it does prolong the inflammatory response and the duration of antibiotic use, as well as delay the recovery of immune function.

Key words: ventilator-associated pneumonia, Candida albicans, Pseudomonas aeruginosa, colonization, co-exist

中图分类号:

R332

王丽辉, 张伟俊, 杨思敏, 朱琤, 林彬, 皋源, 向淑麟, 余跃天. 白念珠菌气道定植对铜绿假单胞菌所致呼吸机相关性肺炎的影响[J]. 首都医科大学学报, 2024, 45(2): 187-193.

Wang Lihui, Zhang Weijun, Yang Simin, Zhu Cheng, Lin Bin, Gao Yuan, Xiang Shulin, Yu Yuetian. The impact of Candida albicans colonization in the airway on ventilator-associated pneumonia caused by Pseudomonas aeruginosa[J]. Journal of Capital Medical University, 2024, 45(2): 187-193.

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白念珠菌气道定植对铜绿假单胞菌所致呼吸机相关性肺炎的影响

The impact of Candida albicans colonization in the airway on ventilator-associated pneumonia caused by Pseudomonas aeruginosa

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