基于支气管洗数据的抗菌疗法的变化改善了ICU患者怀疑肺炎的治疗结果
Bharti Chogtu1, Vrinda Mariya Elenjickal2, Dharma U Shetty2
1Department of Pharmacology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
Critical care research and practice
|August 23, 2023
概括
在怀疑肺炎的重症监护室 (ICU) 患者中,基于支气管支气管洗 (BAL) 的抗微生物治疗方法的改变显著改善了患者的治疗结果,并减少了ICU停留时间. 这凸显了BAL数据在指导有效的抗微生物治疗策略方面的重要性.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 呼吸系统医学 呼吸系统医学
背景情况:
- 灵活的支气管镜检查 (FB) 与支气管泡洗 (BAL) 是诊断重症患者肺炎的常见程序.
- 假设根据BAL发现修改抗菌疗法可以改善患者的治疗结果.
- 本研究研究了BAL引导的抗微生物修饰对重症监护室 (ICU) 患者的结果的影响.
研究的目的:
- 根据BAL报告,根据BAL报告进行抗菌药物治疗的ICU患者和没有接受抗菌药物治疗的ICU患者之间的结局进行比较.
- 评估BAL引导的抗微生物修饰与临床结果之间的关联,包括死亡率和ICU停留时间.
主要方法:
- 一项回顾性队列研究分析了150名ICU患者,他们因疑似肺炎接受了FB.
- 患者被分为两组:那些基于BAL结果的抗微生物修饰者和那些没有.
- 收集的数据包括人口统计,临床症状,实验室结果,微生物学数据,放射学报告,抗菌药物治疗和治疗结果.
主要成果:
- 与没有变化的组 (p=0.018) 相比,BAL引导的抗微生物修改组显示出明显改善的结果 (82个改善 vs. 18个改善) 和较低的死亡率 (23个过期 vs. 12个过期).
- 这一组的ICU总停留时间也较短 (13.12 ± 10.61天 vs 19.43 ± 13.4天,p=0.012) 和从FB到ICU出院的时间较短 (6.33 ± 3.76天 vs 8.46 ± 5.99天,p=0.047).
- 最常见的细菌分离物是Acinetobacter baumanii (30%),其次是Klebsiella pneumoniae (24.66%).
结论:
- 根据BAL数据修改抗微生物治疗与疑似肺炎的重症患者的改善临床结果有关.
- 由BAL引导的抗微生物修改导致ICU停留时间的显著减少.
- Acinetobacter baumanii是通过BAL在这个患者群体中发现的流行病原体.
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