Kooda Kirstin J, Zambrano Alejandra A, Kosaski Dylan L, Higbe Leah, Beam William Brian B, Bohman J Kyle K, Wittwer Erica D, Brady Steven D, LeMahieu Allison M, Fida Madiha, Shah Aditya
Department of Pharmacy Services, Mayo Clinic, Rochester, MN 55902, USA.
Department of Infection Prevention and Control, Mayo Clinic, Rochester, MN 55902, USA.
Antibiotics (Basel). 2024 Jun 26;13(7):590. doi: 10.3390/antibiotics13070590.
While criteria for the diagnosis of nosocomial pneumonias exist, objective definitions are a challenge and there is no gold standard for diagnosis. We analyzed the impact of the implementation of a logical, consensus-based diagnostic and treatment protocol for managing nosocomial pneumonias in the cardiovascular surgery intensive care unit (CVS-ICU).
We conducted a quasi-experimental, interrupted time series analysis to evaluate the impact of a diagnostic and treatment protocol for nosocomial pneumonias in the CVS-ICU. Impacts were measured relative to patient outcomes, diagnostic processes, and antimicrobial stewardship improvement. Descriptive statistics were used to analyze results.
Overall, 35 pre-protocol and 39 post-protocol patients were included. Primary clinical variables suggesting pneumonia in pre- and post-protocol patients were new lung consolidation (50% vs. 71%), new leukocytosis (59% vs. 64%), and positive culture (32% vs. 55%). Appropriate diagnostic testing improved (23% vs. 54%, = 0.008) after protocol implementation. The proportion of patients meeting the criteria for nosocomial pneumonia (77% vs. 87%) was not statistically significant, though more patients in the post-protocol group met probable diagnostic criteria (51% vs. 77%). Duration of therapy was not significantly different (6 days [IQR = 5.0, 10.0] vs. 7 days [IQR = 6.0, 9.0]).
The implementation of a diagnostic and treatment protocol for management of nosocomial pneumonias in the CVS-ICU resulted in improved diagnostic accuracy, advanced antimicrobial and diagnostic stewardship efforts, and laboratory cost savings without an adverse impact on patient-centered outcomes.
虽然存在医院获得性肺炎的诊断标准，但客观定义具有挑战性，且尚无诊断的金标准。我们分析了在心血管外科重症监护病房（CVS-ICU）实施基于共识的合理诊断和治疗方案对管理医院获得性肺炎的影响。
我们进行了一项准实验性中断时间序列分析，以评估CVS-ICU中医院获得性肺炎诊断和治疗方案的影响。相对于患者结局、诊断过程和抗菌药物管理改善情况来衡量影响。使用描述性统计分析结果。
总体而言，纳入了35例方案实施前患者和39例方案实施后患者。方案实施前后提示肺炎的主要临床变量为新出现的肺部实变（50%对71%）、新出现的白细胞增多（59%对64%）和培养阳性（32%对55%）。方案实施后，适当的诊断检测有所改善（23%对54%，P = 0.008）。符合医院获得性肺炎标准的患者比例（77%对87%）无统计学意义，不过方案实施后组中更多患者符合可能的诊断标准（51%对77%）。治疗持续时间无显著差异（6天[四分位间距=5.0，10.0]对7天[四分位间距=6.0，9.0]）。
在CVS-ICU实施医院获得性肺炎诊断和治疗方案可提高诊断准确性，推进抗菌药物和诊断管理工作，并节省实验室成本，且对以患者为中心的结局无不利影响。
