Department of Medicine, University of Toronto, Ontario, Canada.
Department of Pharmacy, Sunnybrook Health Sciences Centre, Ontario, Canada.
Clin Infect Dis. 2018 Aug 1;67(4):513-518. doi: 10.1093/cid/ciy120.
Prophylactic antimicrobial therapy is frequently prescribed for acute aspiration pneumonitis, with the intent of preventing the development of aspiration pneumonia. However, few clinical studies have examined the benefits and harms of this practice.
A retrospective cohort study design was used to compare outcomes of patients with aspiration pneumonitis who received prophylactic antimicrobial therapy with those managed with supportive care only during the initial 2 days following macroaspiration. The primary outcome was in-hospital mortality within 30 days. Secondary outcomes included transfer to critical care and antimicrobial therapy received between days 3 and 14 following macroaspiration including escalation of therapy and antibiotic-free days.
Among 1483 patients reviewed, 200 met the case definition for acute aspiration pneumonitis, including 76 (38%) who received prophylactic antimicrobial therapy and 124 (62%) who received supportive management only. After adjusting for patient-level predictors, antimicrobial prophylaxis was not associated with any improvement in mortality (odds ratio, 0.9; 95% confidence interval [CI], 0.4-1.7; P = .7). Patients receiving prophylactic antimicrobial therapy were no less likely to require transfer to critical care (5% vs 6%; P = .7) and subsequently received more frequent escalation of antibiotic therapy (8% vs 1%; P = .002) and fewer antibiotic-free days (7.5 vs 10.9; P < .0001).
Prophylactic antimicrobial therapy for patients with acute aspiration pneumonitis does not offer clinical benefit and may generate antibiotic selective pressures that results in the need for escalation of antibiotic therapy among those who develop aspiration pneumonia.
预防性使用抗菌药物治疗常被用于预防急性吸入性肺炎的发生，但很少有临床研究探讨这种做法的益处和危害。
本研究采用回顾性队列设计，比较了接受预防性抗菌治疗与仅接受支持治疗的宏吸入后最初 2 天的吸入性肺炎患者的结局。主要结局为 30 天内院内死亡率。次要结局包括入住重症监护病房、宏吸入后第 3 天至第 14 天期间接受的抗菌治疗，包括治疗升级和抗生素无用药天数。
在纳入的 1483 例患者中，有 200 例符合急性吸入性肺炎的病例定义，其中 76 例（38%）接受了预防性抗菌治疗，124 例（62%）仅接受了支持治疗。在校正患者水平预测因素后，预防性抗菌治疗与死亡率的改善无关（比值比，0.9；95%置信区间 [CI]，0.4-1.7；P =.7）。接受预防性抗菌治疗的患者转入重症监护病房的可能性更小（5% vs 6%；P =.7），随后接受更频繁的抗生素治疗升级（8% vs 1%；P =.002）和更少的抗生素无用药天数（7.5 天 vs 10.9 天；P <.0001）。
对于急性吸入性肺炎患者，预防性使用抗菌药物并不能带来临床获益，反而可能导致抗生素选择性压力增加，使那些发生吸入性肺炎的患者需要升级抗生素治疗。
