初始抗生素选择对普通病房重症社区获得性肺炎患者预后的影响  

Effect of initial antibiotic selection on the prognosis of severe community-acquired pneumonia patients in general wards

作　　者：贺刚 杜飞 HE Gang;DU Fei(Department of Respiratory Medicine,the Third Affiliated Hospital of Zunyi Medical University/the First People′s Hospital of Zunyi,Zunyi,Guizhou 563000,China)

机构地区：[1]遵义医科大学第三附属医院/遵义市第一人民医院呼吸内科,贵州遵义563000

出　　处：《现代医药卫生》2020年第18期2886-2889,共4页Journal of Modern Medicine & Health

基　　金：贵州省遵义市科学技术局科技计划项目(遵市科合社字〔2013〕02号)。

摘　　要：目的探讨普通病房重症社区获得性肺炎(CAP)患者在入院时初始抗生素选择对其预后的影响。方法选取该院呼吸内科普通病房2017年1月至2018年1月收治的94例CAP患者,根据2007年美国传染病学会(IDSA)/美国胸科学会(ATS)标准判断重症CAP。收集24 h内的初始抗生素治疗方案。统计临床资料、不良结果(治疗失败和住院死亡的综合结果),以及入院后30 d评估无住院时间。结果94例CAP患者中,50例(53.2%)为重症CAP。重症CAP患者最常见的病原菌是金黄色葡萄球菌(28.6%)和肺炎克雷伯菌(28.6%),其次是铜绿假单胞菌(19.0%)。重症CAP患者的血培养阳性率明显高于非重症CAP患者(23.8%、4.5%),差异有统计学意义(P=0.008)。42.6%的CAP患者和65.0%的重症CAP患者选择的初始抗生素治疗方案与IDSA/ATS指南不一致。多因素分析显示,年龄[比值比(OR)=1.10,95%可信区间(95%CI):1.01~1.10,P=0.010]、合并症(OR=0.14,95%CI:0.08~0.21,P=0.032)和初始抗生素治疗不符合重症监护病房(ICU)重症CAP指南(OR=4.60,95%CI:1.30~17.10,P=0.020)是重症CAP患者不良预后的独立危险因素。结论ICU外的重症CAP患者应进行适当的初始抗生素选择,以改善预后。Objective To explore the effect of initial antibiotic selection on prognosis of severe community-acquired pneumonia in general ward.Methods A total of 94 CAP patients admitted to the Department of Respiratory Medicine of the hospital from January,2017 to Juanuary,2018 were selected,and severe CAP was judged according to the 2007 American Infectious Disease Society(IDSA)/American Thoracic Society(ATS)standards.Collectting the initial antibiotic treatment plan within 24 hours.Clinical data,adverse results(combined results of treatment failure and hospital death)were counted,and no hospitalization time was evaluated 30 d after admission.Results Among 94 cases CAP patients,50 cases(53.2%)were severe CAP.The most common pathogens in severe CAP patients were staphylococcus aureus(28.6%)and klebsiella pneumoniae(28.6%),followed by Pseudomonas aeruginosa(19.0%).The positive rate of blood culture in patients with severe CAP was significantly higher than that of patients with non-severe CAP(23.8%,4.5%),and the difference was statistically significant(P=0.008).The initial antibiotic regimen selected by 42.6%of CAP patients and 65.0%of severe CAP patients were inconsistent with IDSA/ATS guidelines.Multivariate analysis showed age[odds ratio(OR)=1.10,95%confidence interval(95%CI):1.01—1.10,P=0.010],complications(OR=0.14,95%CI:0.08-0.21,P=0.032)and initial antibiotic treatment did not meet the intensive care unit(ICU)severe CAP guidelines(OR=4.60,95%CI:1.30—17.10,P=0.020)were independent risk factor for poor prognosis in patients with severe CAP.Conclusion Patients with severe CAP outside the ICU should undergo appropriate initial antibiotic selection to improve the prognosis.

关 键 词：抗生素 重症社区获得性肺炎 普通病房 重症监护病房 预后 

分 类 号：R563.1[医药卫生—呼吸系统]