抗生素监测,以确定适当的初始实证抗生素治疗,用于呼吸机相关的肺炎
Andrew J Kerwin1, G Christopher Wood2, Saskya Byerly1
1Department of Surgery, Division of Trauma and Surgical Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Surgical infections
|February 24, 2025
概括
抗生素治疗呼吸机相关肺炎 (VAP) 往往是不合适的,因为变化的病原体敏感性. 对局部抗生素的持续监测对于有效的VAP治疗方案至关重要.
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
- 临床微生物学 临床微生物学
背景情况:
- 呼吸器相关肺炎 (VAP) 的经验性抗生素治疗方案由局部抗生素图指导.
- 对于VAP,不适当的经验性抗生素治疗 (IEAT) 在约15%的病例中发生.
- 病原体敏感性模式的变化可能需要对VAP治疗方案进行调整.
研究的目的:
- 审查创伤重症监护室 (TICU) 的抗生素图表,以改变敏感性模式.
- 为了确定当前的VAP治疗方案是否需要根据不断变化的耐药性进行调整.
- 评估随着时间的推移,IEAT和抗菌素使用的趋势.
主要方法:
- 在2017年至2022年期间被诊断患有VAP的TICU患者的回顾性审查.
- 对支气管支气管洗培养 (≥100,000 CFU/mL) 的分析,以确定病原体及其敏感性.
- 评估IEAT百分比和每1000天 (2018-2022) 的抗菌天数的变化.
主要成果:
- 从2017年开始,观察到IEAT的增长趋势.
- 早期的VAP显示了格拉姆阴性分离物的增加 (7%-24%),特别是 * 伪白 * (3%-10%), * 链球菌 * 和 * 血球菌流感 * 的减少.
- 晚期VAP显示增加了*Stenotrophomonas* (3% -5%) 和*Acinetobacter* (4% -10%) 的分离物.
- 抗菌剂的使用发生了转变,塞法林,万科米辛,塞费皮姆和梅罗的使用率增加,安培/苏尔巴克坦和皮佩拉西林/塔扎巴克坦的使用率下降.
结论:
- 病原体流行率的转变和IEAT的增加强调了持续抗生素监测的必要性.
- 局部抗生素图谱数据对于完善VAP实证抗生素治疗方案至关重要.
- 持续监测可以指导及时调整抗微生物药物管理和治疗疗效.
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