通过诊断管理改善抗生素对呼吸机相关肺炎的使用:一项概念验证混合方法研究
Ravi K Tripathi1, Blaine Kenaa2, Kimberly C Claeys3
1Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
通过修改下呼吸道 (LRT) 培养报告,可以改善呼吸机相关肺炎 (VAP) 的诊断管理. 这种干预措施减少了对VAP的抗生素使用,当培养物缺乏明显的肺炎指标时.
科学领域:
- 传染性疾病 传染性疾病
- 临界护理医学 临界护理医学
- 临床微生物学 临床微生物学
背景情况:
- 呼吸机相关性肺炎 (VAP) 经常因有阳性呼吸道培养而过度治疗,而没有明显的肺炎临床症状.
- 诊断管理对于优化重症监护室 (ICU) 抗生素使用至关重要.
研究的目的:
- 为了评估下呼吸道 (LRT) 修改的影响,培养报告对疑似VAP的抗生素处方进行了评估.
- 在呼吸道培养报告阶段评估诊断管理的有效性.
主要方法:
- 一项混合方法研究,涉及基线评估和两名成年ICU的非随机干预.
- 干预:修改了LRT培养报告,以表明不符合肺炎标准的培养物可能被殖民,根据医生使用标准算法进行审查.
- 基线和干预期间之间对VAP进行抗生素处方的比较.
主要成果:
- 在基线时,对VAP的抗生素治疗在不适当的LRT培养中更频繁地识别病原体 (46%),而不是没有增长 (23%).
- 在干预期间,对具有潜在病原体的不适当LRT培养物的修改报告导致VAP抗生素治疗完成率显著降低 (18%与基线组的46%相比).
结论:
- 在临床肺炎特征的指导下,修改LRT培养报告可以促进VAP的诊断管理.
- 这种方法有助于减少在重症监护机构中不必要的抗生素治疗.
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