经验性抗生素治疗对耐碳青霉烯类革兰阴性菌（CRGNB）感染性肺炎30天死亡率和住院时间的影响。
Effect on 30-day mortality and duration of hospitalization of empirical antibiotic therapy in CRGNB-infected pneumonia.
作者信息
Li Rongrong, Tang Hao, Xu Huaming, Cui Kunwei, Li Shujin, Shen Jilu
机构信息
Department of Clinical Laboratory, The Second People's Hospital of Hefei City, Hefei, Anhui Province, China.
Fourth Affiliated Hospital of Anhui Medical University Laboratory, Hefei, 230012, China.
出版信息
Ann Clin Microbiol Antimicrob. 2021 Mar 7;20(1):15. doi: 10.1186/s12941-021-00421-2.
BACKGROUND
The objective of this study was to investigate whether unreasonable empirical antibiotic treatment (UEAT) had an impact on 30-day mortality and duration of hospitalization in bacterial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB).
METHODS
This was a retrospective cohort study involving CRGNB-infected pneumonia. All CRGNB-infected pneumonia patients received empirical and targeted antibiotic treatment (TAT), and they were divided into reasonable empirical antibiotic treatment (REAT) and UEAT according to whether the empirical antibiotic treatment (EAT) was reasonable. The data of the two groups were compared to analyze their influence on the 30-day mortality and hospitalization time in CRGNB-infected pneumonia patients. Moreover, we also considered other variables that might be relevant and conducted multivariable regression analysis of 30-day mortality and duration of hospitalization in CRGNB-infected pneumonia patients.
RESULTS
The study collected 310 CRGNB-infected pneumonia patients, the most common bacterium is Acinetobacter baumannii (211/310 [68%]), the rest were Klebsiella pneumoniae (46/310 [15%]), Pseudomonas aeruginosa and others (53/310 [17%]). Among them, 76/310 (24.5%) patients received REAT. In the analysis of risk factors, dementia, consciousness were risk factors of 30-day mortality, pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. The analysis of 30-day mortality showed that UEAT was not associated with 30-day mortality for the 30-day mortality of REAT and UEAT were 9 of 76 (11.84%) and 36 of 234 (15.38%) (P = 0.447), respectively. Meanwhile, there was difference between REAT and UEAT (P = 0.023) in the analysis of EAT on hospitalization time in CRGNB-infected pneumonia patients.
CONCLUSIONS
UEAT was not associated with 30-day mortality while was related to duration of hospitalization in CRGNB-infected pneumonia patients, in which Acinetobacter baumanniii accouned for the majority.
背景
本研究的目的是调查不合理经验性抗生素治疗（UEAT）是否对耐碳青霉烯类革兰阴性菌（CRGNB）引起的细菌性肺炎患者的30天死亡率和住院时间产生影响。
方法
这是一项涉及CRGNB感染肺炎的回顾性队列研究。所有CRGNB感染肺炎患者均接受经验性和针对性抗生素治疗（TAT），并根据经验性抗生素治疗（EAT）是否合理分为合理经验性抗生素治疗（REAT）组和UEAT组。比较两组数据，分析其对CRGNB感染肺炎患者30天死亡率和住院时间的影响。此外，我们还考虑了其他可能相关的变量，并对CRGNB感染肺炎患者的30天死亡率和住院时间进行多变量回归分析。
结果
本研究收集了310例CRGNB感染肺炎患者，最常见的细菌是鲍曼不动杆菌（211/310 [68%]），其余为肺炎克雷伯菌（46/310 [15%]）、铜绿假单胞菌等（53/310 [17%]）。其中，76/310（24.5%）例患者接受了REAT。在危险因素分析中，痴呆、意识是30天死亡率的危险因素，肺部疾病、培养当天的血流动力学支持和近期手术是住院时间延长的危险因素。30天死亡率分析显示，UEAT与30天死亡率无关，REAT组和UEAT组的30天死亡率分别为76例中的9例（11.84%）和234例中的36例（15.38%）（P = 0.447）。同时，在分析EAT对CRGNB感染肺炎患者住院时间的影响时，REAT组和UEAT组之间存在差异（P = 0.023）。
结论
UEAT与CRGNB感染肺炎患者的30天死亡率无关，但与住院时间有关，其中鲍曼不动杆菌占大多数。
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