Sekandarzad Asieb, Flügler Annabelle, Rheinboldt Anne, Rother David, Först Gesche, Rieg Siegbert, Supady Alexander, Lother Achim, Staudacher Dawid Leander, Wengenmayer Tobias, Kern Winfried V, Biever Paul Marc
Interdisciplinary Medical Intensive Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Division of Infectious Diseases, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Front Med (Lausanne). 2025 May 22;12:1549355. doi: 10.3389/fmed.2025.1549355. eCollection 2025.
Critically ill patients in the intensive care unit (ICU) who are suspected of having pneumonia are frequently treated with broad-spectrum antimicrobials even when the diagnosis remains uncertain. While appropriate antimicrobial therapy offers undeniable benefits, its inappropriate or excessive use can lead to harmful side effects. This study examines the impact of an antimicrobial stewardship program (ASP) in the ICU on both diagnostic accuracy and antimicrobial consumption in critically ill patients with pneumonia.
This cohort study compares a prospective cohort with matched controls from a retrospective sample in the ICU of a tertiary hospital. An ASP was implemented focusing on microbiological sampling of bacteria and antimicrobial therapy. Primary endpoint was days of therapy (DOTs). Secondary endpoints were number of respiratory samples (RS), identification of relevant bacteria in RS and diagnostic accuracy of pneumonia. Clinical safety outcome parameters were length of stay, length of invasive mechanical ventilation and ICU mortality until day 28.
A total of 200 patients were assigned to the intervention group (IG) and 200 to the control group (CG). The overall DOTs per patient were 12.95 [95% confidence interval (CI) 11.42 to 14.47] in the CG compared to 9.91 (CI 8.97 to 10.82) in the IG ( = 0.036), with no unfavorable findings in safety outcome parameters. DOTs for meropenem were 2.74 (CI 2.14 to 3.34) in the CG vs. 1.13 (CI 0.76 to 1.49) in the IG ( < 0.001), DOTs for piperacillin/tazobactam were 3.66 (CI 3.16 to 4.15) vs. 2.78 (CI 2.33 to 3.22; = 0.011), and DOTs for ampicillin/sulbactam were 1.49 (CI 1.15 to 1.82) vs. 2.63 (CI 2.25 to 3.02; < 0.001). Relevant bacteria in RS were detected more frequently in the IG, with = 91 compared to = 61 in the CG ( = 0.003).
Implementation of an ASP in the ICU effectively reduces broad-spectrum antimicrobial consumption in critically ill patients with pneumonia without compromising patient safety.
重症监护病房（ICU）中疑似患有肺炎的重症患者即使在诊断仍不确定时也经常接受广谱抗菌药物治疗。虽然适当的抗菌治疗带来了不可否认的益处，但其不当或过度使用可能会导致有害的副作用。本研究探讨了ICU中的抗菌药物管理计划（ASP）对重症肺炎患者诊断准确性和抗菌药物使用的影响。
这项队列研究将一个前瞻性队列与一家三级医院ICU中回顾性样本的匹配对照组进行比较。实施了一项侧重于细菌微生物采样和抗菌治疗的ASP。主要终点是治疗天数（DOTs）。次要终点是呼吸道样本数量（RS）、RS中相关细菌的鉴定以及肺炎的诊断准确性。临床安全结局参数为住院时间、有创机械通气时间和至第28天的ICU死亡率。
共有200名患者被分配到干预组（IG），200名患者被分配到对照组（CG）。CG组每位患者的总体DOTs为12.95[95%置信区间（CI）11.42至14.47]，而IG组为9.91（CI 8.97至10.82）（P = 0.036），安全结局参数未发现不利结果。美罗培南的DOTs在CG组为2.74（CI 2.14至3.34），而在IG组为1.13（CI 0.76至1.49）（P < 0.001），哌拉西林/他唑巴坦的DOTs为3.66（CI 3.16至4.15）对2.78（CI 2.33至3.22；P = 0.011），氨苄西林/舒巴坦钠的DOTs为1.49（CI 1.15至1.82）对2.63（CI 2.25至3.02；P < 0.001）。IG组RS中检测到相关细菌的频率更高，IG组为91例，而CG组为61例（P = 0.003）。
在ICU中实施ASP可有效降低重症肺炎患者的广谱抗菌药物使用量，且不影响患者安全。
