Pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage in intensive care unit

Abstract

Objective To analyze the pathogenic features and risk factors of hospital-acquired pneumonia in patients with acute spontaneous intracerebral hemorrhage (sICH) in intensive care unit (ICU). Methods The clinical data of 110 patients with sICH admitted in ICU during January 2015 and February 2017 were collected. Patients were divided into hospital-acquired pneumonia group (HAP group, n=66) and non-HAP group (n=44). Multivariate Logistic regression was used to study the risk factors of HAP, and pathogen distribution and drug susceptibility were analyzed. Results Multivariate Logistic regression demonstrated that long-term mechanical ventilation (OR=1.028, 95%CI 1.012-1.044, P<0.01), lower score of glasgow coma scale (GCS) (OR=1.550, 95%CI 1.148-2.093, P<0.01), prolonged hospital stay (OR=1.131, 95%CI 1.046-1.224, P<0.01) and underlying diseases more than two forms (OR=9.793, 95%CI 1.012-1.044, P<0.01) were the independent risk factors of HAP, while high plasma albumin level was protective factor for HAP (OR=0.897, 95%CI 0.811-0.992, P<0.05). One hundred and eighty-three bacterial strains were isolated from 66 patients, the top 4 pathogens were Acinetobacter baumannii (28.96%, 53/183), Klebsiella pneumonia (15.85%, 29/183), Pseudomonas aeruginosa (13.11%, 24/183) and Staphylococcus aureus (12.02%, 22/183). Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were highly resistant to the majority of antibiotics, some of which even reached 100%. Staphylococcus aureus showed high resistance to macrolides, fluoroquinolones and β-lactam antibiotics. Conclusions There is high incidence of HAP in patients with sICH, and the pathogenic bacteria are mainly gram-negative bacteria. Effective prevention and treatment measures should be taken to reduce the incidence of HAP for patients with sICH in ICU. Key words: Cerebral hemorrhage; Intensive care unit; Hospital-acquired pneumonia; Pathogen distribution; Risk factors