Zhang Di, Yang Guan, Hu Xingang, Liu Xiaoming, Zhang Jie, Jia Dongqing, Zhang Aojun
School of Computer Science, Zhongyuan University of Technology, Zhengzhou, 450007, China.
Zhengzhou Key Laboratory of Text Processing and Image Understanding, Zhengzhou, State, 450007, China.
BMC Pulm Med. 2024 Dec 18;24(1):621. doi: 10.1186/s12890-024-03441-8.
Aspiration pneumonia (AP) is a common complication in the intensive care unit (ICU), which is associated with significantly increased morbidity and mortality and has a significant impact on patient prognosis. Antibiotics are commonly used in the clinical treatment of AP. However, the prognostic impact of antibiotics on patients with AP has not been adequately characterized. The purpose of this study is to illustrate the relationship between the use of antibiotics and in-hospital mortality of AP patients, as well as to analyze the effects of different antibiotic treatment regimens on the prognosis of the patients, and to further understand the distribution of pathogens and drug resistance in AP patients, so as to provide guidance information for the rational use of medication for patients in the clinic.
Clinical data of AP patients were extracted from the MIMIC-IV database. Statistical methods included multivariate logistic regression, propensity score matching (PSM), and inverse probability weighting (IPW) based on propensity scores to ensure the robustness of the findings. In addition, the characteristics of the medications used by patients with AP were described using statistical graphs and tables.
A total of 4132 patients with AP were included. In-hospital mortality was significantly lower in the group using antibiotics compared to the group not using antibiotics (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.27- 0.71, P = 0.001). Furthermore, in the group using mechanical ventilation (MV), antibiotics use significantly reduced in-hospital mortality (OR = 0.30, 95% CI 0.15-0.57, P < 0.001). Vancomycin and cephalosporins are the most commonly used antibiotics to treat AP. Specifically, vancomycin in combination with piperacillin-tazobactam was used most frequently with 396 cases. The highest survival rate (97.6%) was observed in patients treated with levofloxacin combined with metronidazole. Additionally, vancomycin combined with piperacillin-tazobactam had many inflammation related features that differed significantly from those in patients who did not receive medication.
Antibiotics use is closely associated with lower in-hospital mortality in ICU patients with AP. Moreover, understanding antibiotics use, the composition of pathogenic bacteria, and the rates of drug resistance in patients with AP can aid in disease prevention and prompt infection control.
吸入性肺炎（AP）是重症监护病房（ICU）常见的并发症，与发病率和死亡率显著增加相关，对患者预后有重大影响。抗生素常用于AP的临床治疗。然而，抗生素对AP患者预后的影响尚未得到充分描述。本研究的目的是阐明抗生素使用与AP患者院内死亡率之间的关系，分析不同抗生素治疗方案对患者预后的影响，并进一步了解AP患者的病原体分布和耐药情况，以便为临床患者合理用药提供指导信息。
从MIMIC-IV数据库中提取AP患者的临床数据。统计方法包括多因素逻辑回归、倾向评分匹配（PSM）和基于倾向评分的逆概率加权（IPW），以确保研究结果的稳健性。此外，使用统计图和表格描述AP患者使用药物的特征。
共纳入4132例AP患者。使用抗生素的组院内死亡率显著低于未使用抗生素的组（优势比[OR]=0.44，95%置信区间[CI]0.27-0.71，P=0.001）。此外，在使用机械通气（MV）的组中，使用抗生素显著降低了院内死亡率（OR=0.30，95%CI 0.15-0.57，P<0.001）。万古霉素和头孢菌素是治疗AP最常用的抗生素。具体而言，万古霉素联合哌拉西林-他唑巴坦使用最为频繁，共396例。左氧氟沙星联合甲硝唑治疗的患者生存率最高（97.6%）。此外，万古霉素联合哌拉西林-他唑巴坦有许多与炎症相关的特征，与未接受药物治疗的患者有显著差异。
抗生素的使用与ICU中AP患者较低的院内死亡率密切相关。此外，了解AP患者的抗生素使用情况、病原菌组成和耐药率有助于疾病预防和及时控制感染。
