Division of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Crit Care. 2019 Dec;54:14-19. doi: 10.1016/j.jcrc.2019.06.026. Epub 2019 Jun 28.
This study investigated the outcomes of antimicrobial de-escalation (ADE) based on mortality and the incidence of multi-drug resistant (MDR) pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis and septic shock.
We retrospectively analyzed patients diagnosed with severe pneumonia requiring intensive care unit (ICU) admission and possessing negative microbiological culture results at a tertiary referral hospital in South Korea from March 2008 to July 2018.
We identified 107 patients with culture-negative pneumonia. The Acute Physiologic and Chronic Health Evaluation (APACHE) II and Sepsis-related Organ Failure Assessment (SOFA) mean scores were 20.3 ± 8.6 and 9.6 ± 3.3, respectively. Among the patients, 40 (37.4%) underwent ADE. The APACHE II, SOFA, and follow-up SOFA scores did not differ significantly between the groups, and no differences were found in ICU mortality and MDR pathogen occurrence (27.5% vs 41.8%, P = .137 and 15.0% vs 16.9% P = .794, respectively).
We observed similar ICU mortality and MDR pathogen occurrence in patients with culture-negative pneumonia presenting with sepsis/shock regardless of whether they received ADE. Additionally, ADE lowered the antimicrobial burden.
本研究旨在探讨在脓毒症和感染性休克患者中，基于死亡率和多药耐药（MDR）病原体发生率的抗菌药物降级（ADE）的结果，这些患者表现为培养阴性肺炎。
我们回顾性分析了 2008 年 3 月至 2018 年 7 月在韩国一家三级转诊医院因重症肺炎需要入住重症监护病房（ICU）且微生物培养结果为阴性的患者。
我们共确定了 107 例培养阴性肺炎患者。急性生理学和慢性健康评估（APACHE）Ⅱ和与脓毒症相关的器官衰竭评估（SOFA）评分均值分别为 20.3±8.6 和 9.6±3.3。其中，40 例（37.4%）患者接受了 ADE。两组患者的 APACHE Ⅱ、SOFA 和随访 SOFA 评分无显著差异，ICU 死亡率和 MDR 病原体发生率也无差异（27.5%比 41.8%，P=0.137 和 15.0%比 16.9%，P=0.794）。
我们观察到，无论是否接受 ADE，在脓毒症/感染性休克患者中，培养阴性肺炎患者的 ICU 死亡率和 MDR 病原体发生率相似。此外，ADE 降低了抗菌药物的负担。
