下呼吸道样本的微生物学分析:它是否会影响社区感染肺炎患者的结果?
Peter Ellekvist1, Hans Johan Niklas Lorentsson1, Kåre Nielsen1
1Department of Infectious Diseases, Herlev and Gentofte Hospital, Herlev, Denmark.
概括
在社区获得性肺炎 (CAP) 中进行广泛的呼吸道采样并没有显著改变患者的结果. 然而,微生物学分析影响了本随机试验中大量患者的抗生素治疗决定.
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) 的管理依赖于及时诊断和适当的抗菌药物治疗.
- 广泛的下呼吸道采样在指导CAP治疗决策中的作用仍然是需要研究的领域.
研究的目的:
- 评估下呼吸道密集采样和微生物分析对CAP治疗调整和患者结果的影响.
- 为了比较严格的抽样与标准护理在一个潜在的随机试验.
主要方法:
- 一项前性随机试验,涉及118名患有CAP的患者.
- 患者被分配到严格采样 (干预) 或标准护理 (控制) 中.
- 主要结局:基于微生物学结果的抗生素治疗变化;次要结局:输液治疗持续时间,住院,死亡率,再入院.
主要成果:
- 由于对照组中医生的自由裁量权,采样频率在两组之间变得相似.
- 微生物学分析导致28%的干预组和30%的对照组改变了抗生素治疗.
- 总体而言,34%的样本患者进行了治疗调整,往往导致使用更广泛的抗生素,两组之间的二次结果没有显著差异.
结论:
- 严格的下呼吸道采样并没有显著改善CAP中的患者结果.
- 然而,微生物学分析影响了相当一部分患者的治疗决策.
- 需要在经验广泛的抗生素使用环境中进行进一步的研究,以澄清对治疗决策的影响.
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