Pouliot Jonathon D, Dortch Marcus J, Givens Gabrielle, Tidwell William, Hamblin Susan E, May Addison K
Department of Pharmacy Practice, Lipscomb University College of Pharmacy and Health Sciences, Nashville, TN, USA.
T2Biosystems, Lexington, MA, USA.
Hosp Pharm. 2021 Oct;56(5):444-450. doi: 10.1177/0018578720918548. Epub 2020 May 5.
Diagnostic criterion for pneumonia includes clinical data and bronchoalveolar lavage cultures (BALCx) to identify pathogens. Although ~60% of BALCx are negative, there may be reluctance to discontinue antibiotics, leading to prolonged antibiotic use (PAU). The purpose of this study is to compare outcomes of subjects with negative BALCx with PAU versus without prolonged antibiotic use (nPAU). A retrospective cohort study was conducted including subjects admitted to the intensive care unit (ICU), with suspected pneumonia, and negative BALCx. Data were compared based on length of exposure to antibiotics, PAU (antibiotics >4 days) versus nPAU (antibiotics <4 days). A total of 128 subjects were included, 57 in the PAU group and 71 in the nPAU group. Baseline demographics were similar between groups. Severity of illness measured by multiple organ dysfunction scores at time of bronchoalveolar lavage (BAL) collection to final result showed a statistically significant decrease in the PAU group but not in the nPAU group. No differences were found in ICU days, ventilator-free days, or mortality; however, length of stay was longer for PAU (23 vs. 17, = .04). In the PAU group, there were fewer BALCx results of "no growth" (23% vs. 45%, = .04), more positive gram stains (83% vs. 60%, = .01) and more positive non-BALCx (40% vs. 14%, = .01). In a multivariate analysis, factors associated with PAU were positive BAL gram stains (adjusted odds ratio [aOR] 3.1, = .037) and positive non-BALCx (aOR 4.7, = .002). For subjects with suspected pneumonia and negative BALCx, positive non-BALCx and positive BALCx gram stain influenced the length of exposure of antibiotics.
肺炎的诊断标准包括临床数据和支气管肺泡灌洗培养（BALCx）以识别病原体。尽管约60%的BALCx结果为阴性，但可能仍不愿停用抗生素，导致抗生素使用时间延长（PAU）。本研究的目的是比较BALCx结果为阴性且使用抗生素时间延长的患者与未延长抗生素使用时间（nPAU）的患者的结局。进行了一项回顾性队列研究，纳入了入住重症监护病房（ICU）、疑似肺炎且BALCx结果为阴性的患者。根据抗生素暴露时间进行数据比较，PAU组（抗生素使用>4天）与nPAU组（抗生素使用<4天）。共纳入128名患者，PAU组57名，nPAU组71名。两组的基线人口统计学特征相似。从支气管肺泡灌洗（BAL）采集时的多器官功能障碍评分到最终结果所测量的疾病严重程度在PAU组有统计学意义的下降，而在nPAU组则没有。在ICU住院天数、无呼吸机天数或死亡率方面未发现差异；然而，PAU组的住院时间更长（23天对17天，P = 0.04）。在PAU组中，“无生长”的BALCx结果较少（23%对45%，P = 0.04），革兰氏染色阳性更多（83%对60%，P = 0.01），非BALCx阳性更多（40%对14%，P = 0.01）。在多变量分析中，与PAU相关的因素是BAL革兰氏染色阳性（调整后的优势比[aOR] 3.1，P = 0.037）和非BALCx阳性（aOR 4.7，P = 0.002）。对于疑似肺炎且BALCx结果为阴性的患者，非BALCx阳性和BALCx革兰氏染色阳性影响抗生素的暴露时间。
