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在烧伤ICU患者中,针对肺炎的甲基西林耐药黄金葡萄球菌鼻拭子的预测值

Zachary Carlson¹, Robyn Stoianovici¹, Sierra Young¹

¹Department of Clinical Pharmacy, UC Davis Medical Center, Sacramento, CA, USA.

Burns : journal of the International Society for Burn Injuries

|September 24, 2024

概括

在怀疑肺炎的烧伤ICU患者中,阴性MRSA鼻子拭子具有高度的特异性和准确性,可以排除感染. 这可以帮助降低抗生素的升级,但重复的扫描可能是有益的.

科学领域:

传染性疾病传染性疾病
关键护理医学关键护理医学
烧伤手术烧伤手术

背景情况:

肺炎是烧伤重症监护室 (ICU) 患者常见的并发症.
准确的早期诊断对于适当的抗生素选择和缓和至关重要.

研究的目的:

为了评估甲素耐药黄金葡萄球菌 (MRSA) 的诊断性能,在烧伤ICU患者中为肺炎进行鼻腔抹拭.
为了确定MRSA鼻的灵敏度,特异性,正预测值 (PPV) 和负预测值 (NPV).

主要方法:

成年烧伤ICU患者 (2016-2021) 的回顾性队列研究.
纳入标准:烧伤,肺炎诊断,入院时的MRSA鼻子抹布,以及超过5天抗生素的呼吸道培养物.
与抗生素启动相比,抽样时间的分析.

主要成果:

在136名患者中有267例肺炎病例.
总的来说,MRSA鼻的敏感性:39%,特异性:98.7%,PPV:84.2%,NPV:89.9%.
抗生素抽样<7天:特异性为98.6%,NPV为98.6%. 抽样>=7天:特异性为98.7%,净净值为86.4%.

结论:

MRSA鼻的高特异性和NPV表明,在怀疑肺炎的稳定烧伤患者中,抗MRSA抗生素的降级实用性,特别是当从抗生素开始后获得<7天时.
随着后期抽样的NPV下降,表明定期重复抽样的潜在好处.
阴性MRSA鼻可以指导这种脆弱患者群体的抗生素管理.

关键词:

烧烧烧烧烧烧烧烧烧烧烧烧烧烧烧在ICU中,医生会对患者进行治疗.鼻子上的MRSA抽样.在MRSA肺炎的肺炎.

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