Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil; Hospital Alemão Oswaldo Cruz, Unidade de Tratamento Intensivo, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas (HCFMUSP), Departamento de Cirurgia, Disciplina de Cirurgia Geral e Traumatologia, São Paulo, SP, Brazil.
Braz J Anesthesiol. 2024 May-Jun;74(3):744454. doi: 10.1016/j.bjane.2023.07.011. Epub 2023 Aug 3.
Pneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population.
Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed.
The study included 177 patients with chest trauma and pulmonary contusion on CT scan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09-0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05-1.36; p < 0.01).
Empiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.
约 20%的肺挫伤创伤患者会发生肺炎。本研究旨在评估该人群中经验性抗生素治疗与医院获得性肺炎之间的关系。
回顾性纳入入住创伤外科 ICU 的成年患者队列。抗生素治疗组（ATG）定义为入院后静脉使用抗生素超过 48 小时，而保守治疗组（CG）定义为抗生素使用不超过 48 小时。主要结局为入院后 14 天内微生物学确诊的医院获得性肺炎。采用 logistic 回归估计组间分配与主要结局之间的关联。进行了探索性分析，以评估肺炎中耐药菌株与抗生素使用之间的关联。
本研究纳入了 177 例胸部创伤和 CT 扫描显示肺挫伤的患者。与 CG 相比，ATG 患者的病情更严重，表现为更高的损伤严重程度评分、SAPS3、SOFA 评分、更高的机械通气率和更长的机械通气时间。在多变量分析中，ATG 与主要结局发生率降低相关（OR = 0.25，95%CI 0.09-0.64；p < 0.01）。使用另一组变量进行的敏感性分析也得出了类似的结果。然而，抗生素使用的每一天与感染患者中耐药菌肺炎的风险增加相关（OR = 1.18/天，95%CI 1.05-1.36；p < 0.01）。
在肺挫伤的危重症患者中，经验性抗生素治疗与医院获得性肺炎发生率降低独立相关。然而，抗生素使用的每一天都与感染患者中耐药菌株的增加相关。
