Du Wei, Chen Hong, Xiao Shuzhen, Tang Wei, Shi Guochao
Department of Pulmonary Medicine Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2017 Mar;96(13):e6439. doi: 10.1097/MD.0000000000006439.
Gram-negative bacterial infections, especially multidrug-resistant (MDR) bacterial infection, are becoming a serious threat to public health. Although it is widely accepted that both appropriate initial empirical therapy and targeted therapy are important, but for patients needing therapy adjustment, few studies have explored whether adjustment strategy based on microbiologic susceptibility test (MST) brings better outcome compared with empirical adjustment.A total of 320 patients with gram-negative bacterial infection (airway, blood, or pleural effusion) were selected and a prospective cohort study was conducted. Baseline characteristics and outcomes (microbiologic, clinical, and economic) were documented during follow-up.MDR and nosocomial infections were common among subjects. Initial therapies consistent with MST could result in reduced in-hospital mortality, treatment failure rate, infection-related death, percentages of patients needing therapy adjustment, and daily hospitalization cost with increased successful treatment rate compared with inconsistent with MST, and microbiologic outcomes were also better with appropriate therapies.For patients needing therapy adjustment, relying on MST gained no significant benefit on mortality, clinical, or microbiologic outcomes compared with depending on clinical experience. But for patients with MDR infection, adjustment relying on MST gained more benefit than non-MDR infection.Appropriate initial therapy significantly improved the prognosis of patients with gram-negative bacterial infections, but improvement was not that obvious for patients needing therapy adjustment which was based on MST compared with clinical experience, and more beneficial effects of adjustment relying on MST were obtained for patients with MDR bacterial infection.
革兰氏阴性菌感染，尤其是多重耐药（MDR）菌感染，正成为对公共卫生的严重威胁。尽管人们普遍认为适当的初始经验性治疗和靶向治疗都很重要，但对于需要调整治疗方案的患者，很少有研究探讨基于微生物药敏试验（MST）的调整策略与经验性调整相比是否能带来更好的治疗结果。
总共选取了320例革兰氏阴性菌感染（呼吸道、血液或胸腔积液）患者，并进行了一项前瞻性队列研究。在随访期间记录基线特征和结果（微生物学、临床和经济学方面）。
MDR和医院感染在研究对象中很常见。与MST一致的初始治疗与不一致的初始治疗相比，可降低住院死亡率、治疗失败率、感染相关死亡率、需要调整治疗的患者百分比以及每日住院费用，同时提高成功治疗率，并且适当的治疗在微生物学结果方面也更好。
对于需要调整治疗的患者，与依靠临床经验相比，依靠MST在死亡率、临床或微生物学结果方面没有显著益处。但对于MDR感染患者，依靠MST进行调整比非MDR感染患者获益更多。
适当的初始治疗显著改善了革兰氏阴性菌感染患者的预后，但对于需要基于MST进行治疗调整的患者，与临床经验相比改善并不明显，而对于MDR菌感染患者，依靠MST进行调整获得了更多有益效果。
