Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia.
Clinica Universidad de La Sabana, Chia, Colombia.
Crit Care. 2024 Nov 22;28(1):381. doi: 10.1186/s13054-024-05180-y.
Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines, there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.
The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests. Multivariable analysis using multiple regression analysis was used to assess the relationship between reported antibiotic duration and organisational variables collected in the study.
A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the diagnostic processes, including clinical assessment, where 30% (389) did not consider radiological evidence essential to diagnose pneumonia, variable collection of microbiological samples, and use and practice in bronchoscopy. Microbiological diagnostics were least frequently available in low and lower-middle-income nation settings. Modal intended antibiotic treatment duration was 5-7 days for all types of pneumonia. Shorter durations of antibiotic treatment were associated with antimicrobial stewardship (AMS) programs, high national income status, and formal intensive care training.
This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardized approaches to diagnosing and treating pneumonia in the ICU. Trial registration As a survey of current practice, this study was not registered. It was reviewed and endorsed by the European Society of Intensive Care Medicine.
肺炎仍然是一个重大的全球健康问题，特别是在需要入住重症监护病房（ICU）的人群中。尽管有国际指南，但临床管理仍存在异质性。D-PRISM 研究旨在全面了解全球 ICU 中肺炎（即社区获得性肺炎（CAP）、医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP））的诊断和治疗方法，并比较全球临床实践的差异。
D-PRISM 研究是一项多国家、基于调查的研究，旨在评估 ICU 中肺炎的诊断和治疗。2022 年 9 月至 11 月期间，向来自 72 个国家的重症监护临床医生分发了一份自我管理的在线问卷。问卷包括专业概况、CAP、HAP 和 VAP 的诊断和管理当前临床实践以及微生物学诊断测试的可用性等部分。使用多元回归分析对报告的抗生素持续时间与研究中收集的组织变量之间的关系进行多变量分析。
从 ICU 临床医生那里共收集了 1296 份有效回复，分布在中低收入国家（LMIC）和高收入国家（HIC）之间，其中 LMIC 受访者占 51%。诊断过程存在异质性，包括临床评估，其中 30%（389 人）认为放射学证据对诊断肺炎并非必不可少，微生物样本的采集也存在差异，并且使用和进行支气管镜检查的实践也存在差异。在低收入和中下收入国家，微生物学诊断工具的可用性最低。所有类型肺炎的理想抗生素治疗持续时间为 5-7 天。抗生素治疗持续时间较短与抗菌药物管理（AMS）计划、高国民收入水平和正规重症监护培训有关。
本研究强调了肺炎临床实践和诊断能力的差异，特别是在中低收入国家发现了诊断工具获取方面的问题。显然需要更好地遵守现有指南，并采用标准化方法来诊断和治疗 ICU 中的肺炎。
作为对当前实践的调查，本研究未进行注册。它得到了欧洲重症监护医学学会的审查和认可。
