经验性抗生素利用的批判性分析：建立基准。
Critical analysis of empiric antibiotic utilization: establishing benchmarks.
机构信息
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio OH 44109-1998, USA.
出版信息
Surg Infect (Larchmt). 2010 Apr;11(2):125-31. doi: 10.1089/sur.2009.047.
AIM
We critically evaluated empiric antibiotic practice in the surgical and trauma intensive care unit (STICU) with three specific objectives: (1) To characterize empiric antibiotics practice prospectively; (2) to determine how frequently STICU patients started on empiric antibiotics subsequently have a confirmed infection; and (3) to elucidate the complications associated with unnecessary empiric antibiotic therapy.
METHODS
We collected data prospectively using the Surgical Intensive Care-Infection Registry (SIC-IR) including all 1,185 patients admitted to the STICU for >2 days from March 2007 through May 2008. Empiric antibiotics were defined as those initiated because of suspected infections.
RESULTS
The mean patient age was 56 years and 62% were male. The mean STICU length of stay was eight days, and the mortality rate was 4.6%. Empiric antibiotics were started for 26.3% of the patients. The average length of antibiotic use was three days. Of the 312 patients started on empiric antibiotics, only 25.6% were found to have an infection. Factors associated with correctly starting empiric antibiotics were a longer STICU stay (5 vs. 3 days), prior antibiotics (29% vs. 17%), and mechanical ventilation (93% vs. 79%). Patients who were started on antibiotics without a subsequent confirmed infection were compared with patients not given empiric antibiotics. Incorrect use of empiric antibiotics was associated with younger age (p < 0.001), more STICU days (10.6 vs. 5.9 days; p < 0.001), more ventilator days (p < 0.001), more development of acute renal failure (24.1% vs. 12.1%; p < 0.001), and a significant difference in mortality rate (8.6% vs. 3.2%; p < 0.001).
CONCLUSIONS
After admission to the STICU, 26% of patients received at least one course of empiric antibiotics. Only 25.6% of these patients were confirmed to have an infection. These results provide key benchmark data for the critical care community to improve antibiotic stewardship.
目的
我们通过三个具体目标对外科和创伤加强治疗病房（STICU）中的经验性抗生素治疗进行了批判性评估：（1）前瞻性描述经验性抗生素治疗；（2）确定接受经验性抗生素治疗的 STICU 患者随后有多少例确诊感染；（3）阐明与不必要的经验性抗生素治疗相关的并发症。
方法
我们使用外科强化护理感染登记册（SIC-IR）前瞻性地收集数据，该登记册包括 2007 年 3 月至 2008 年 5 月期间入住 STICU 超过 2 天的 1185 名患者的数据。经验性抗生素是指因疑似感染而开始使用的抗生素。
结果
患者的平均年龄为 56 岁，62%为男性。STICU 的平均住院时间为 8 天，死亡率为 4.6%。26.3%的患者开始使用经验性抗生素。抗生素的平均使用时间为 3 天。在 312 名开始使用经验性抗生素的患者中，只有 25.6%的患者被发现有感染。正确开始经验性抗生素治疗的相关因素包括 STICU 住院时间较长（5 天与 3 天）、先前使用过抗生素（29%与 17%）和机械通气（93%与 79%）。与未接受经验性抗生素治疗的患者相比，接受经验性抗生素治疗但未确认感染的患者。经验性抗生素使用不当与年龄较小（p<0.001）、STICU 天数较多（10.6 天与 5.9 天；p<0.001）、呼吸机天数较多（p<0.001）、急性肾功能衰竭发生率较高（24.1%与 12.1%；p<0.001）和死亡率差异有统计学意义（8.6%与 3.2%；p<0.001）有关。
结论
入住 STICU 后，26%的患者至少接受了一个疗程的经验性抗生素治疗。这些患者中只有 25.6%被确诊感染。这些结果为重症监护界提供了关键的基准数据，以改善抗生素管理。
Zotero 插件