Department of Pharmacy Services, Jackson Memorial Hospital, Miami, FL, USA.
Norton Infectious Diseases Institute, Norton Healthcare, 4950 Norton Healthcare Blvd, Suite 303, Louisville, KY, 40241, USA.
BMC Infect Dis. 2024 Sep 3;24(1):911. doi: 10.1186/s12879-024-09600-w.
The 2016 IDSA guideline recommends a treatment duration of at least 7 days for hospital-acquired (HAP)/ventilator-associated pneumonia (VAP). The limited literature has demonstrated higher rates of recurrence for non-glucose fermenting gram-negative bacilli with short course therapy, raising the concern of optimal treatment duration for these pathogens. Therefore, we aimed to compare the outcomes for patients receiving shorter therapy treatment (≤ 8 days) versus longer regimen (> 8 days) for the treatment of multidrug resistant (MDR) Pseudomonas pneumonia.
A single-center, retrospective cohort study was conducted to evaluate adult patients receiving an antimicrobial regimen with activity against MDR Pseudomonas aeruginosa in respiratory culture between 2017 and 2020 for a minimum of 6 consecutive days. Exclusion criteria were inmates, those with polymicrobial pneumonia, community-acquired pneumonia, and infections requiring prolonged antibiotic therapy.
Of 427 patients with MDR P. aeruginosa respiratory isolates, 85 patients were included. Baseline characteristics were similar among groups with a median age of 65.5 years and median APACHE 2 score of 20. Roughly 75% had ventilator-associated pneumonia. Compared to those who received ≤ 8 days of therapy, no difference was seen for clinical success in patients treated for more than 8 days (80% vs. 65.5%, p = 0.16). The number of 30-day and 90-day in-hospital mortality, 30-days relapse, and other secondary outcomes did not significantly differ among the treatment groups.
Prolonging treatment duration beyond 8 days did not improve patient outcomes for MDR P. aeruginosa HAP/VAP.
2016 年 IDSA 指南建议医院获得性（HAP）/呼吸机相关性肺炎（VAP）的治疗疗程至少为 7 天。有限的文献表明，对于短程治疗的非葡萄糖发酵革兰氏阴性杆菌，复发率更高，这引起了人们对这些病原体最佳治疗持续时间的关注。因此，我们旨在比较接受较短疗程治疗（≤8 天）与较长疗程（>8 天）的患者治疗多药耐药（MDR）铜绿假单胞菌肺炎的结局。
进行了一项单中心回顾性队列研究，以评估 2017 年至 2020 年期间至少连续 6 天接受呼吸培养中对 MDR 铜绿假单胞菌具有活性的抗菌方案治疗的成年患者。排除标准为囚犯、患有混合性肺炎、社区获得性肺炎以及需要长期抗生素治疗的感染患者。
在 427 例 MDR 铜绿假单胞菌呼吸道分离株患者中，有 85 例患者被纳入研究。各组间的基线特征相似，中位年龄为 65.5 岁，中位急性生理学和慢性健康状况评分系统 II（APACHE II）评分为 20。约 75%的患者患有呼吸机相关性肺炎。与接受≤8 天治疗的患者相比，治疗超过 8 天的患者临床成功率无差异（80% vs. 65.5%，p=0.16）。30 天和 90 天院内死亡率、30 天复发率和其他次要结局在治疗组之间无显著差异。
将治疗时间延长至 8 天以上不会改善 MDR 铜绿假单胞菌 HAP/VAP 患者的结局。
