高危气管插管患者早期肺炎单剂量抗生素预防的影响。
Influence of Single-Dose Antibiotic Prophylaxis for Early-Onset Pneumonia in High-Risk Intubated Patients.
机构信息
University of North Carolina Medical Center, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
出版信息
Neurocrit Care. 2018 Jun;28(3):362-369. doi: 10.1007/s12028-017-0490-8.
BACKGROUND
Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes.
METHODS
This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h.
RESULTS
Among the 172 patients included, use of an EOP prophylaxis protocol resulted in a significant reduction in the rate of microbiologically confirmed EOP compared to those without prophylaxis (7.4 vs 19.8%, p = 0.026). However, EOP prophylaxis did not decrease the combined incidence of microbiologically confirmed or clinically suspected EOP (32.2 vs 37.4%, p = 0.523). No difference in the rate of late-onset pneumonia (34.6 vs 26.4%, p = 0.25) or virulent organism growth (19.8 vs 14.3%, p = 0.416) was observed. No difference was observed in the duration of intubation, duration of intensive care unit (ICU) stay, duration of hospitalization, or ICU antibiotic days within 30 days of intubation. In hospital mortality was found to be higher in those who received EOP prophylaxis compared to those who did not receive prophylaxis (45.7 vs 29.7%, p = 0.04).
CONCLUSIONS
The administration of a single antibiotic dose following intubation may reduce the incidence of microbiologically confirmed EOP in patients with neurologic injury who are intubated ≥ 72 h. A prophylaxis strategy does not appear to increase the rate of virulent organism growth or the rate of late-onset pneumonia. However, this practice is not associated with a decrease in days of antibiotic use in the ICU or any clinical outcomes benefit.
背景
气管插管后早发性肺炎（EOP）在伴有神经损伤的危重症患者中很常见，与更差的临床结局相关。
方法
本回顾性队列研究观察了在实施 EOP 预防方案前后的结局，该方案包括在插管时给予单剂量头孢曲松 2 g。该研究纳入了 2014 年 4 月 1 日至 2016 年 10 月 26 日期间入住北卡罗来纳大学医学中心（UNCMC）神经重症监护病房（NSICU）并插管时间≥72 h 的年龄≥18 岁的患者。
结果
在纳入的 172 例患者中，与未预防组相比，使用 EOP 预防方案可显著降低微生物学确诊 EOP 的发生率（7.4%比 19.8%，p=0.026）。然而，EOP 预防并不能降低微生物学确诊或临床疑似 EOP 的综合发生率（32.2%比 37.4%，p=0.523）。未观察到迟发性肺炎（34.6%比 26.4%，p=0.25）或毒力生物体生长（19.8%比 14.3%，p=0.416）的发生率差异。插管时间、重症监护病房（ICU）住院时间、住院时间或插管后 30 天内 ICU 抗生素使用天数无差异。与未接受预防的患者相比，接受 EOP 预防的患者住院死亡率更高（45.7%比 29.7%，p=0.04）。
结论
在插管后给予单剂量抗生素可能会降低神经损伤患者中插管时间≥72 h 的患者微生物学确诊 EOP 的发生率。预防策略似乎不会增加毒力生物体生长或迟发性肺炎的发生率。然而，这种做法与 ICU 抗生素使用天数或任何临床结局获益无关。
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