Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan, USA.
Respirology. 2017 Nov;22(8):1656-1661. doi: 10.1111/resp.13111. Epub 2017 Jul 4.
Pneumonia is a common admitting diagnosis in the intensive care unit (ICU). When aspiration is suspected, antibiotics to cover anaerobes are frequently used, but in the absence of clear risk factors, current guidelines have questioned their role. It is unknown how frequently these guidelines are followed.
We conducted a single-centre observational study on practice patterns of anaerobic antibiotic use in consecutive patients admitted to the ICU with aspiration pneumonia (Asp), community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP).
A total of 192 patients were studied (Asp: 20, HCAP: 107, CAP: 65). Overall, 59 patients received anaerobic antibiotics (Asp: 90%, HCAP: 28%, CAP 17%) but a significant proportion of these patients did not meet criteria to receive them. Inappropriate anaerobic antibiotic use was 12/20 for Asp, 27/107 for HCAP and 9/65 for CAP. Mortality probability model III at zero hours (MPM0) score and a diagnosis of Asp were predictors of receiving inappropriate anaerobic antibiotics. Receiving inappropriate anaerobic antibiotics was associated with a longer ICU length of stay (LOS; 7 days (interquartile range (IQR): 7-21) vs 4 days (IQR:2-9), P = 0.017).
For patients in the ICU admitted with pneumonia, there is a high occurrence of inappropriately prescribed anaerobic antibiotics, the use of which was associated with a longer ICU LOS.
肺炎是重症监护病房（ICU）常见的收治诊断。当怀疑发生吸入时，常使用覆盖厌氧菌的抗生素，但在没有明确危险因素的情况下，目前的指南对其作用提出了质疑。目前尚不清楚这些指南的遵循频率如何。
我们对连续入住 ICU 的吸入性肺炎（Asp）、社区获得性肺炎（CAP）和医疗保健相关性肺炎（HCAP）患者的厌氧菌抗生素使用情况进行了一项单中心观察性研究。
共研究了 192 名患者（Asp：20 例，HCAP：107 例，CAP：65 例）。总体而言，59 名患者接受了厌氧菌抗生素（Asp：90%，HCAP：28%，CAP：17%），但其中相当一部分患者不符合使用这些抗生素的标准。不合理使用厌氧菌抗生素的情况在 Asp 患者中为 12/20，在 HCAP 患者中为 27/107，在 CAP 患者中为 9/65。零小时（MPM0）评分和 Asp 诊断是接受不合理厌氧菌抗生素治疗的预测因素。接受不合理厌氧菌抗生素治疗与 ICU 住院时间（LOS）延长相关（7 天（四分位距：7-21）与 4 天（四分位距：2-9），P=0.017）。
对于入住 ICU 的肺炎患者，不合理使用厌氧菌抗生素的情况较为常见，且其使用与 ICU LOS 延长相关。
