Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Clin Infect Dis. 2010 Apr 1;50(7):945-52. doi: 10.1086/651075.
The 2005 guidelines of the American Thoracic Society-Infectious Diseases Society of America Guidelines for Hospital for managing hospital-acquired pneumonia classified patients according to time of onset and risk factors for potentially drug-resistant microorganisms to select the empirical antimicrobial treatment. We assessed the microbial prediction and validated the adequacy of these guidelines for antibiotic strategy.
We prospectively observed 276 patients with intensive care unit-acquired pneumonia. We classified patients into group 1 (early onset without risk factors for potentially drug-resistant microorganisms; 38 patients) and group 2 (late onset or risk factors for potentially drug-resistant microorganisms; 238 patients). We determined the accuracy of guidelines to predict causative microorganisms and the influence of guidelines adherence in patients' outcome.
Microbial prediction was lower in group 1 than in group 2 (12 [50%] of 24 vs 119 [92%] of 129; P < .001) mainly because of potentially drug-resistant microorganisms in 10 patients (26%) from group 1. Guideline adherence was higher in group 2 (153 [64%] vs 7 [18%]; P < .001). Guideline adherence resulted in more treatment adequacy than did nonadherence (69 [83%] vs 45 [64%]; P = .013) and a trend toward better response to empirical treatment in group 2 only but did not influence mortality. Reclassifying patients according to the risk factors for potentially drug-resistant microorganisms of the former 1996 American Thoracic Society guidelines increased microbial prediction in group 1 to 21 (88%; P = .014); all except 1 patient with potentially drug-resistant microorganisms were correctly identified by these guidelines.
The 2005 guidelines predict potentially drug-resistant microorganisms worse than the 1996 guidelines. Adherence to guidelines resulted in more adequate treatment and a trend to a better clinical response in group 2, but it did not influence mortality.
2005 年美国胸科学会-传染病学会医院获得性肺炎管理指南根据发病时间和潜在耐药微生物的危险因素对患者进行分类，以选择经验性抗菌治疗。我们评估了微生物预测，并验证了这些指南在抗生素策略中的充分性。
我们前瞻性观察了 276 例重症监护病房获得性肺炎患者。我们将患者分为 1 组（早期发病且无潜在耐药微生物危险因素；38 例）和 2 组（晚期发病或有潜在耐药微生物危险因素；238 例）。我们确定了指南预测病原体的准确性以及指南遵循对患者结局的影响。
1 组的微生物预测低于 2 组（24 例中的 12 例[50%]与 129 例中的 119 例[92%]；P<0.001），主要是因为 1 组中有 10 例（26%）患者存在潜在耐药微生物。2 组的指南遵循率较高（153 例[64%]与 7 例[18%]；P<0.001）。与不遵循指南相比，遵循指南导致治疗更充分（69 例[83%]与 45 例[64%]；P=0.013），仅在 2 组中经验性治疗的反应趋势更好，但不影响死亡率。根据 1996 年美国胸科学会指南中潜在耐药微生物的危险因素重新分类 1 组患者，将微生物预测提高到 21 例（88%）；所有潜在耐药微生物患者均被这些指南正确识别。
2005 年指南预测潜在耐药微生物的能力不如 1996 年指南。遵循指南导致 2 组治疗更充分且临床反应趋势更好，但不影响死亡率。
