Attridge Russell T, Frei Christopher R, Pugh Mary Jo V, Lawson Kenneth A, Ryan Laurajo, Anzueto Antonio, Metersky Mark L, Restrepo Marcos I, Mortensen Eric M
Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209; Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229.
College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229.
J Crit Care. 2016 Dec;36:265-271. doi: 10.1016/j.jcrc.2016.08.004. Epub 2016 Aug 11.
Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP.
We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model.
A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). Patients receiving GC-HCAP had higher 30-day patient mortality compared to GC-CAP patients (34% vs 22%; P< .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (odds ratio, 1.67; 95% confidence interval, 1.30-2.13), recent hospital admission (1.53; 1.15-2.02), and receipt of GC-HCAP therapy (1.51; 1.20-1.90).
Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.
近期数据表明，对于医疗保健相关性肺炎（HCAP）患者，给予符合指南（GC）的抗生素治疗并未改善预后。本研究旨在评估入住重症监护病房（ICU）的HCAP患者的健康结局与GC治疗之间的关系。
我们在美国退伍军人健康管理系统中对150多家医院收治的患者进行了一项基于人群的队列研究，以比较接受GC-HCAP治疗、GC社区获得性肺炎（GC-CAP）治疗或非GC治疗的HCAP ICU患者的基线特征、细菌病原体和健康结局。主要结局是30天患者死亡率。在多变量逻辑回归模型中评估主要结局的危险因素。
共有3593例患者符合纳入标准，接受了GC-HCAP治疗（26%）、GC-CAP治疗（23%）或非GC治疗（51%）。与GC-CAP患者相比，接受GC-HCAP治疗的患者30天死亡率更高（34%对22%；P<0.0001）。在控制混杂因素后，30天患者死亡率的危险因素包括使用血管升压药（比值比，1.67；95%置信区间，1.30-2.13）、近期住院（1.53；1.15-2.02）和接受GC-HCAP治疗（1.51；1.20-1.90）。
我们的数据未显示接受GC-HCAP治疗的HCAP ICU患者的预后得到改善。
