Walaiporn Wangchinda, Samuel L Aitken, Megan E Klatt, Paul R Lephart, Aaron B Smith, Jason M Pogue
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引用次数: 0
摘要
背景：指南建议对重症监护病房（ICU）患者由革兰阴性菌引起的肺炎进行经验性治疗时采用双重抗伪菌治疗。此外，在选择最佳经验性治疗方案时，建议考虑当地的药敏数据和患者的特异性耐药风险因素。然而，目前还缺乏评估如何才能最好地做到这一点的数据，也不清楚是基于当地药敏数据的方法还是基于患者特异性风险因素的方法能更好地推动适当的经验性治疗。本研究旨在比较这两种策略：这项回顾性研究分为两个阶段。方法：这项回顾性研究分为两个阶段。在第一阶段，利用重症监护病房患者的革兰氏阴性呼吸道培养物来制定特定单位的联合抗生素图谱，并查看患者的个人病历以评估风险因素对抗菌药物敏感性的影响，从而制定基于风险因素的治疗算法。然后根据这两种策略确定了最佳经验治疗方案。在第二阶段，将这些方案假设应用于患者，以比较两种方法的适当经验疗法率和过度使用率：结果：与根据抗生素图谱得出的治疗方案相比，基于风险因素的治疗方案的适当率更高（89.9% vs 83.7%）。此外，与基于患者特异性风险因素的方法相比（69.8% 对 40.3%），基于抗生素图的方案导致抗生素过度使用的比例更高，而过度使用的原因是更频繁地使用不必要的联合疗法：结论：在经验性抗生素选择方面，两种方法的适当性都很高。结论：在经验性抗生素选择方面，两种方法的适当率都很高，但基于患者特异性风险因素的方法显示出更高的适当治疗率，并在减少不必要的联合治疗方面具有优势。
A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Pneumonia Caused by Gram-Negative Bacteria in Intensive Care Units: Unit-Specific Combination Antibiograms Versus Patient-Specific Risk Factors.
Background: Guidelines suggest dual antipseudomonal therapy for empiric treatment of pneumonia caused by gram-negative bacteria in intensive care unit (ICU) patients. Additionally, consideration of local susceptibility data and patient-specific risk factors for resistance is recommended for selecting optimal empiric regimens. However, data assessing how to best do this are lacking, and it is unclear whether a local susceptibility data-based or a patient-specific risk factor-based approach will better drive appropriate empiric treatment. This study aims to compare these 2 strategies.
Methods: This retrospective study was divided into 2 periods. In period I, gram-negative respiratory cultures from ICU patients were used to develop unit-specific combination antibiograms, and individual patient charts were reviewed to assess the impact of risk factors on antimicrobial susceptibility to develop a risk factor-based treatment algorithm. Optimal empiric regimens based on these 2 strategies were then defined. In period II, these regimens were hypothetically applied to patients to compare rates of appropriate empiric therapy and overuse by the 2 methods.
Results: Risk factor-based regimens had a higher appropriateness rate compared to regimens derived from antibiograms (89.9% vs 83.7%). Additionally, applying antibiogram-based regimens resulted in a higher prevalence of antibiotic overuse than a patient-specific risk factor-based approach (69.8% vs 40.3%), with excess overuse driven by a higher frequency of unnecessary use of combination therapy.
Conclusions: Both strategies provided high rates of appropriateness in empiric antibiotic selection. However, the patient-specific risk factor-based approach demonstrated a higher rate of appropriate therapy and offered advantages in reducing rates of unnecessary combination therapy.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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