Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona.
Critical Care Department, Vall d'Hebron Hospital, Universitat Autonoma de Barcelona and Medicine Department, Vall d'Hebron Institut de Recerca (VHIR), Barcelona.
Chest. 2014 Jul;146(1):22-31. doi: 10.1378/chest.13-1531.
The objective of the present study was to compare antibiotic prescribing practices and survival in the ICU for patients with pneumococcal severe community-acquired pneumonia (SCAP) between 2000 and 2013.
This was a matched case-control study of two prospectively recorded cohorts in Europe. Eighty patients from the Community-Acquired Pneumonia en la Unidad de Cuidados Intensivos (CAPUCI) II study (case group) were matched with 80 patients from CAPUCI I (control group) based on the following: shock at admission, need of mechanical ventilation, COPD, immunosuppression, and age.
Demographic data were comparable in the two groups. Combined antibiotic therapy increased from 66.2% to 87.5% (P < .01), and the percentage of patients receiving the first dose of antibiotic within 3 h increased from 27.5% to 70.0% (P < .01). ICU mortality was significantly lower (OR, 0.82; 95% CI, 0.68-0.98) in cases, both in the whole population and in the subgroups of patients with shock (OR, 0.67; 95% CI, 0.50-0.89) or receiving mechanical ventilation (OR, 0.73; 95% CI, 0.55-0.96). In the multivariate analysis, ICU mortality increased in patients requiring mechanical ventilation (OR, 5.23; 95% CI, 1.60-17.17) and decreased in patients receiving early antibiotic treatment (OR, 0.36; 95% CI, 0.15-0.87) and combined therapy (OR, 0.19; 95% CI, 0.07-0.51).
In pneumococcal SCAP, early antibiotic prescription and use of combination therapy increased. Both were associated with improved survival.
本研究旨在比较 2000 年至 2013 年期间，重症肺炎球菌性社区获得性肺炎（SCAP）患者的抗生素使用情况和 ICU 生存率。
这是一项在欧洲进行的前瞻性记录的队列研究的病例对照研究。80 例来自社区获得性肺炎重症加强护理病房（CAPUCI）II 研究（病例组）的患者与 80 例来自 CAPUCI I（对照组）的患者相匹配，匹配因素包括入院时休克、需要机械通气、COPD、免疫抑制和年龄。
两组的人口统计学数据相当。联合抗生素治疗的比例从 66.2%增加到 87.5%（P<0.01），抗生素首剂在 3 小时内使用的比例从 27.5%增加到 70.0%（P<0.01）。ICU 死亡率在病例组显著降低（OR，0.82；95%CI，0.68-0.98），无论是在总体人群中还是在休克（OR，0.67；95%CI，0.50-0.89）或需要机械通气（OR，0.73；95%CI，0.55-0.96）的亚组中均如此。在多变量分析中，需要机械通气的患者 ICU 死亡率增加（OR，5.23；95%CI，1.60-17.17），而接受早期抗生素治疗（OR，0.36；95%CI，0.15-0.87）和联合治疗（OR，0.19；95%CI，0.07-0.51）的患者 ICU 死亡率降低。
在肺炎球菌性 SCAP 中，早期抗生素处方和联合治疗的使用增加，两者均与生存率的提高相关。
