呼吸机相关性肺炎初始抗菌药物选择与预后的相关性研究  

Relationship between initial empirical antimicrobial agents choice and prognosis in ventilator-associated pneumonia:a retrospective cohort study

作　　者：费晓云[1,2] 胡必杰[1] 陈雪华[1] 李华茵[1] 高晓东[1] 

机构地区：[1]复旦大学附属中山医院呼吸科,上海200032 [2]上海市第六人民医院呼吸内科,上海200233

出　　处：《中华医院感染学杂志》2011年第12期2573-2575,共3页Chinese Journal of Nosocomiology

摘　　要：目的评价呼吸机相关性肺炎(VAP)的初始抗菌药物选择是否按照诊治指南及是否能够覆盖病原菌与VAP病死率之间的关系。方法对2003年1月-2005年11月复旦大学附属中山医院ICU内发生的56例VAP病例,进行回顾性队列研究;多因素logistic回归分析初始抗菌药物的规范性与是否有效覆盖病原菌对VAP预后的影响。结果初始抗菌药物病原菌覆盖组和未覆盖组VAP的病死率分别为32.4%和60.0%(P=0.023);根据美国胸科协会/美国感染性疾病协会(ATS/IDSA)指南治疗与对照组的病死率分别为38.3%和52.9%(P=0.473)。结论初始抗菌治疗是否覆盖肺炎病原菌是影响VAP预后的独立危险因素;使用ATS/IDSA指南推荐的抗菌药物,未发现能有效降低VAP病死率。OBJECTIVE To evaluate the relationship between initial empirical antimicrobial agents,which is in accordance with the ATS/IDSA guideline recommendation or is sensitive to pneumonia pathogen,with the prognosis in ventilator-associated pneumonia.METHODS A retrospective cohort study among 56 patients developing VAP in ICUs of Zhongshan Hospital of Fudan University from Jan 2003 to Sep 2005 was performed;the impossibility of initial antimicrobial agents covering VAP pathogens or whether it went by the guideline recommended by ATS/IDSA could affect the prognosis of VAP were identified by multiple Logistic regression analysis.RESULTS The fatal rates of initial antimicrobial agents covering or not covering VAP pathogens were 32.4% and 60.0%,respetively P=0.023;while the fatal rates of according to ATS/IDSA guideline or not were 38.3% and 52.9%,respectively,P=0.473.CONCLUSIONS Failure to cover VAP pathogens by initial antimicrobial agents is a independent risk factor for prognosis of VAP.Choosing initial antimicrobial agents according to ATS/IDSA guideline is not identified to effectively reduce the fatal rate of VAP.

关 键 词：呼吸机相关性肺炎 抗菌药物 预后 指南 

分 类 号：R969.3[医药卫生—药理学]