社区获得性肺炎中耐药病原体的危险因素:系统性审查和元分析
Natsuki Nakagawa1,2, Masahiro Katsurada3,2, Yosuke Fukuda4
1Department of Respiratory Medicine, The University of Tokyo Hospital, Tokyo, Japan.
鉴定社区获得性肺炎 (CAP) 耐药病原体的风险因素是有效抗生素治疗的关键. 本综述强调了11个因素,包括先前的抗生素使用和慢性肺病,以指导初始治疗决策.
科学领域:
- 传染性疾病 传染性疾病
- 肺部病理学 肺部病理学
- 临床微生物学 临床微生物学
背景情况:
- 社区获得性肺炎 (CAP) 仍然是一个重大的全球健康威胁,需要明智地使用抗生素.
- 评估耐药病原体 (DRP) 的风险对于优化CAP管理中的实证抗生素选择至关重要.
- 这项研究解决了需要更好的风险分层在CAP治疗.
研究的目的:
- 系统地审查和元分析与CAP患者的DRP相关的风险因素.
- 专门评估所有患者队列 (包括培养负病例) 中的这些风险因素.
主要方法:
- 24项相关研究的系统审查和元分析.
- 研究的分类为全患者队列和培养阳性肺炎队列.
- 基于对常见的CAP抗生素耐药性的CAP-DRPs的定义.
主要成果:
- 在全患者队列中发现了CAP-DRPs的11个显著风险因素.
- 关键的风险因素包括先前的DRP感染/殖民,气管切除术,严重的呼吸衰竭和先前的抗生素使用.
- 其他已确定的因素包括慢性肺病,COPD,伤口护理,神经疾病,先前住院治疗,养老院住宿和日常生活中的低活动.
结论:
- 这是第一个专门研究CAP-DRPs风险因素的系统审查,单独分析队列.
- 来自全患者队列的发现对于在临床实践中指导初始抗菌药物治疗选择具有高度相关性.
- 鉴定的风险因素可以为CAP-DRPs的预测模型的开发提供信息,从而改善患者的治疗结果.
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