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华西医学  2015 

初始抗生素治疗医疗机构相关性肺炎的临床效果比较

DOI: 10.7507/1002-0179.20150291, PP. 1011-1014

Keywords: 医疗机构相关性肺炎,抗生素,临床效果

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Abstract:

目的?探讨医疗机构相关性肺炎(HCAP)的初始经验性治疗方案的选择。方法?回顾性分析2014年1月1日-12月31日收治的156例HCAP患者,分为喹诺酮单药治疗组84例和两联抗多重耐药治疗组72例。比较两组患者的一般资料、肺炎严重程度(PSI)评分、多重耐药菌检出率、抗生素更换比例、平均抗生素使用时间、平均住院时间、机械通气使用例数、转入重症监护病房(ICU)比例、30d病死率。结果?喹诺酮单药治疗组男46例,女38例,年龄(59.9±10.9)岁,PSI评分(89.5±22.7)分;两联抗多重耐药治疗组男44例,女28例,年龄(62.2±12.2)岁,PSI评分(94.4±23.6)分,两组患者的性别构成、年龄、PSI评分差异均无统计学意义(P>0.05);喹诺酮单药治疗组抗生素使用时间为(14.5±3.7)d,长于两联抗多重耐药治疗组(12.8±3.8)d,差异有统计学意义(P=0.005);喹诺酮单药治疗组的多重耐药菌检出率、更换抗生素的比例、平均住院时间、机械通气使用例数、转入ICU比例、30d病死率等分别为17.9%、34.5%、(16.9±3.6)d、11.9%、9.5%、4.8%,两联抗多重耐药治疗组分别为15.3%、22.2%、(17.3±3.9)d、16.8%、12.5%、4.2%,两组指标比较差异均无统计学意义(P>0.05)。结论?对于HCAP患者,不应盲目采用抗多重耐药抗菌素治疗,应结合危险因素及当地微生物学流行特征,采用个体化的治疗方案。

References

[1]  2 Shindo Y, Ito R, Kobayashi D, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2013, 188(8): 985-995.
[2]  3 Nakagawa N, Saito Y, Sasaki M, et al. Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia[J]. Geriatr Gerontol Int, 2014, 14(2): 362-371.
[3]  4 Umeki K, Tokimatsu I, Yasuda C, et al. Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia[J]. Respirology, 2011, 16(5): 856-861.
[4]  5 Viasus D, Garcia-Vidal C, Cruzado JM, et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease[J]. Nephrol Dial Transplant, 2011, 26(9): 2899-2906.
[5]  6 Micek ST, Kollef KE, Reichley RM, et al. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience[J]. Antimicrob Agents Chemother, 2007, 51(10): 3568-3573.
[6]  7 Rello J, Luján M, Gallego M, et al. Why mortality is increased in health-care-associated pneumonia: lessons from pneumococcal bacteremic pneumonia[J]. Chest, 2010, 137(5): 1138-1144.
[7]  8 Attridge RT, Frei CR, Restrepo MI, et al. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia[J]. Eur Respir J, 2011, 38(4): 878-887.
[8]  9 Cao G, Chen X, Wu S. Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department[J].Chin Med J (Engl), 2014, 127(10):1814-1819.
[9]  10 European Society of Clinical Microbiology and Infectious Diseases, European Respiratory Society. Guidelines for the management of adult lower respiratory tract infections[J]. Clin Microbiol Infect, 2011, 17(Suppl6): 1-59.
[10]  11 Carratalà J, Mykietiuk A, Fernández-Sabé N, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes[J]. Arch Intern Med, 2007, 167(13): 1393-1399.
[11]  12 Park SC, Kang YA, Park BH, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia[J]. Respir Med, 2012, 106(9): 1311-1319.
[12]  13 Kawasaki S, Aoki N, Kikuchi H, et al. Clinical and microbiological evaluation of hemodialysis-associated pneumonia (HDAP): should HDAP be included in healthcare-associated pneumonia [J]. J Infect Chemother, 2011, 17(5): 640-645.
[13]  14 Jung JY, Park MS, Kim YS, et al. Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital[J]. BMC Infect Dis, 2011, 11: 61.
[14]  15 Falcone M, Corrao S, Venditti M, et al. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia[J]. Intern Emerg Med, 2011, 6(5): 431-436.
[15]  16 Jeong BH, Koh WJ, Yoo H, et al. Performances of prognostic scoring systems in patients with healthcare-associated pneumonia[J]. Clin Infect Dis, 2013, 56(5): 625-632.
[16]  17 Garcia-Vidal C, Viasus D, Roset A, et al. Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization[J]. Clin Microbiol Infect, 2011, 17(11): 1659-1665.
[17]  18 Taylor SP, Taylor BT. Health care-associated pneumonia in hemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy[J]. Respirology, 2013, 18(2): 364-368.
[18]  19 Maruyama T, Niederman MS, Kobayashi T, et al. A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly[J]. Respir Med, 2008, 102(9): 1287-1295.
[19]  20 Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial[J]. JAMA, 2006, 295(21): 2503-2510.
[20]  1 American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4): 388-416.

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