呼吸机相关性肺炎患者在确定呼吸机相关性条件后开始抗菌治疗的时间与死亡率无关：一项队列研究。

Timing of antimicrobial therapy after identification of ventilator-associated condition is not associated with mortality in patients with ventilator-associated pneumonia: a cohort study.

机构信息

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.

Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; School of Medicine, University of Aberdeen, Aberdeen, Scotland, United Kingdom.

出版信息

PLoS One. 2014 May 19;9(5):e97575. doi: 10.1371/journal.pone.0097575. eCollection 2014.

DOI:10.1371/journal.pone.0097575

PMID:24840503

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4026417/

Abstract

PURPOSE

Delays in antimicrobial therapy increase mortality in ventilator-associated pneumonia (VAP). The more objective ventilator-associated complications (VAC) are increasingly used for quality reporting. It is unknown if delays in antimicrobial administration, after patients meet VAC criteria, leads to worse outcomes.

MATERIALS AND METHODS

Cohort of 81 episodes of antimicrobial treatment for VAP. We compared mortality, superinfections and treatment failures conditional on the timing of identification of VAC.

RESULTS

60% of patients with VAC had an identifiable episode at least 48 before the initiation of antimicrobials. Antimicrobial administration after the identification of VAC was not associated with intensive care unit (ICU) mortality (OR 0.71, 95% CI 0.11-4.48, p = 0.701) compared to immediate antimicrobial administration. Similarly, the risk of treatment failure or superinfection was not affected by the timing of administration of antimicrobials in VAC (HR 0.95, 95% CI 0.42-2.19, p = 0.914).

CONCLUSIONS

We observed no signal of harm associated with the timing to initiate antimicrobials after the identification of a VAC. The identification of VAC should not lead clinicians to start antimicrobials before a diagnosis of VAP can be established.

摘要

目的

抗菌治疗的延迟会增加呼吸机相关性肺炎（VAP）患者的死亡率。越来越多的客观呼吸机相关性并发症（VAC）被用于质量报告。目前尚不清楚在符合 VAC 标准的患者接受抗菌治疗后，抗菌药物的延迟使用是否会导致更差的结局。

材料与方法

这是一项针对 81 例 VAP 抗菌治疗的病例队列研究。我们比较了根据 VAC 识别时间，在治疗结局方面，死亡率、再感染和治疗失败的差异。

结果

60%的 VAC 患者在开始使用抗生素之前至少 48 小时就有可识别的发病事件。与立即使用抗生素相比，在识别 VAC 后使用抗生素与 ICU 死亡率（比值比 0.71，95%置信区间 0.11-4.48，p=0.701）无相关性。同样，VAC 抗生素使用时机与治疗失败或再感染的风险无关（风险比 0.95，95%置信区间 0.42-2.19，p=0.914）。