在重症监护室的抗生素降级实践:一个多中心观察性研究
Asad E Patanwala1,2, Arwa Abu Sardaneh1,2, Jan-Willem C Alffenaar1,3,4
1Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
The Annals of pharmacotherapy
|August 28, 2024
概括
在重症监护室 (ICU) 的抗生素降级 (ADE) 并非总是及时的,40%的患者在24小时内没有接受. 阴性培养与较少的ADE相关,这表明改善的目标.
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
- 药理学 药理学是指药理学的学科.
背景情况:
- 在重症监护室 (ICU) 中围绕抗生素降级 (ADE) 的做法仍然不太了解.
- 优化抗生素使用对于打击抗菌素耐药性和改善患者治疗结果至关重要.
研究的目的:
- 为了确定ICU患者在24小时内及时接受ADE的比例.
- 确定与迅速实施ADE相关的预测因素.
主要方法:
- 在澳大利亚和新西兰的15家医院进行了一项多中心队列研究.
- 分析了在ICU入院24小时内开始使用广谱抗生素的成年患者.
- ADE被定义为切换到更窄频谱的药物或停止使用抗生素,主要结果是可采取行动的培养后24小时内发生的ADE.
主要成果:
- 在446名患者中,161人不符合AE的条件,37人具有不确定的AE状态.
- 在剩余的248名患者中,60.5%的患者在可操作培养后24小时内接受了ADE.
- 阴性培养结果是较不及时ADE的显著预测因素 (OR = 0.48,P = 0.03).
结论:
- 只有60.5%的符合条件的ICU患者在24小时内得到了及时的抗生素降级.
- 阴性培养的患者不太可能及时接受ADE,突出了抗菌药物管理干预的领域.
- 针对具有ADE阴性培养的患者,有可能改善ICU中的整体抗菌药物管理工作.
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