Pneumology Department, Clinic Institute of Thorax, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
Clin Infect Dis. 2010 Aug 1;51 Suppl 1:S48-53. doi: 10.1086/653049.
Hospital-acquired pneumonia is the second most frequent nosocomial infection and the first in terms of morbidity, mortality, and cost. In recent years, international societies and, most recently, the American Thoracic Society jointly with the Infectious Disease Society of America, have developed guidelines for the management of hospital-acquired pneumonia, health care-associated pneumonia, and ventilator-associated pneumonia. These guidelines include recommendations for risk stratification, initial and definitive antibiotic treatment, and prevention. The validation of these guidelines is important because it confirms that they can be used in clinical practice, as quality indicators, and as a standard of care. Several processes can be validated and are included in the guidelines, such as the accuracy of the prediction of microorganisms according to stratification criteria and the impact of guidelines on outcomes, including length of hospital and intensive care unit stay, duration of mechanical ventilation, complications, and in-hospital and 30-day mortality. Clinical studies have shown that the accuracy of predicting microorganisms according to risk stratification is reliable ( approximately 80% and approximately 90%). Three studies suggest that the implementation of guidelines, with a special emphasis on antibiotic treatment, improves several parameters of outcome. Only one study, using a before-and-after design, showed a decrease in 14-day mortality after guidelines implementation. A key issue for these studies is to modify recommendations according to local patterns of microbiology and drug resistance. In summary, implementation of guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia decreases the rate of initial inappropriate antibiotic treatment and decreased 14-day mortality in a study. More clinical studies to validate the influence of guidelines on outcome are warranted.
医院获得性肺炎是第二常见的医院获得性感染，也是发病率、死亡率和费用最高的感染。近年来，国际社会，最近是美国胸科学会与美国传染病学会联合，制定了医院获得性肺炎、医疗保健相关性肺炎和呼吸机相关性肺炎的管理指南。这些指南包括风险分层、初始和明确的抗生素治疗以及预防的建议。这些指南的验证非常重要，因为它证实了它们可以在临床实践中、作为质量指标以及作为护理标准使用。几个过程可以被验证并包含在指南中，例如根据分层标准预测微生物的准确性以及指南对结果的影响，包括住院和重症监护病房停留时间、机械通气时间、并发症以及住院和 30 天死亡率。临床研究表明，根据风险分层预测微生物的准确性是可靠的（约 80%和约 90%）。三项研究表明，实施指南，特别是抗生素治疗，可改善多个结果参数。只有一项研究，采用前后设计，表明在实施指南后 14 天死亡率降低。这些研究的一个关键问题是根据当地的微生物学和药物耐药模式修改建议。总之，实施医院获得性肺炎和呼吸机相关性肺炎管理指南可降低初始不适当抗生素治疗的发生率，并在一项研究中降低 14 天死亡率。需要更多的临床研究来验证指南对结果的影响。
