McGregor Jessina C, Rich Shayna E, Harris Anthony D, Perencevich Eli N, Osih Regina, Lodise Thomas P, Miller Ram R, Furuno Jon P
Oregon State University College of Pharmacy, Portland, OR 97239, USA.
Clin Infect Dis. 2007 Aug 1;45(3):329-37. doi: 10.1086/519283. Epub 2007 Jun 19.
Studies of the association between inappropriate antibiotic therapy and mortality among bacteremic patients have generated conflicting findings. We systematically reviewed these studies to identify methodological heterogeneity that may explain the lack of agreement. We identified 51 articles that met the inclusion criteria, and we extracted the following data: study design, definition and measurement of variables, and statistical methods. Only 8 studies (16%) defined inappropriate antibiotic therapy as that which was inactive in vitro against the isolated organism(s) and not consistent with current clinical practice recommendations and distinguished between empiric and definitive treatment. Thirty-four studies (67%) measured the severity of illness, but only 6 (12%) specified the time at which it was measured. The methodological recommendations suggested in this article are intended to improve the validity and generalizability of future research. In brief, future studies should define "inappropriate" therapy on the basis of in vitro susceptibility data, should separately evaluate empiric and definitive therapy, and should control for the baseline severity of illness.
关于菌血症患者不恰当抗生素治疗与死亡率之间关联的研究得出了相互矛盾的结果。我们系统回顾了这些研究，以确定可能解释为何缺乏一致性的方法学异质性。我们识别出51篇符合纳入标准的文章，并提取了以下数据：研究设计、变量的定义与测量以及统计方法。只有8项研究（16%）将不恰当抗生素治疗定义为体外对分离出的病原体无活性且不符合当前临床实践建议的治疗，并区分了经验性治疗和确定性治疗。34项研究（67%）测量了疾病严重程度，但只有6项（12%）明确了测量的时间。本文提出的方法学建议旨在提高未来研究的有效性和可推广性。简而言之，未来的研究应基于体外药敏数据定义“不恰当”治疗，应分别评估经验性治疗和确定性治疗，并应控制疾病的基线严重程度。
