经验性抗生素使用是否改善了流行性病毒感染的通风患者的结果? 一个多中心的回顾性研究
Elisabeth Papiol1,2,3, Julen Berrueta4,5, Juan Carlos Ruíz-Rodríguez1,2,3
1Intensive Care Department, Vall d'Hebron Universitary Hospital, 08035 Barcelona, Spain.
Antibiotics (Basel, Switzerland)
|June 25, 2025
概括
流行性病毒性肺炎的重症患者经验性抗生素治疗没有减少呼吸器相关的肺炎或没有细菌共感染的死亡率. 以诊断为指导的适当的抗生素使用对于更好的结果至关重要.
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
- 呼吸系统医学 呼吸系统医学
背景情况:
- 在流行性病毒性肺炎中,经验性抗生素治疗 (EAT) 是常见的,但其益处尚不清楚.
- 低细菌共感染率 (COI) 挑战了EAT的常规使用.
- 抗微生物药物管理原则质疑病毒感染中广泛使用的EAT.
研究的目的:
- 为了确定ICU入院时的EAT是否会影响呼吸机相关肺炎 (VAP) 或ICU死亡率.
- 根据确定的细菌COI的存在来分层结果.
- 为了评估EAT在流感A (H1N1) 和COVID-19患者中的有效性.
主要方法:
- 从西班牙ICU注册表 (2009-2021) 分析了4197名成年患者的回顾性分析.
- 患者需要针对流感A ((H1N1) 或COVID-19进行侵入性机械通风.
- 分析的结果包括ICU死亡率和VAP发病率,按已确认的细菌COI分层,使用倾向得分匹配和回归模型.
主要成果:
- 在没有COI的患者中 (n=3543),EAT没有显著降低ICU死亡率 (OR=1.02) 或VAP (OR=1.02).
- 在确诊的COI患者 (n=654) 中,适当的EAT与减少的VAP (17.4%与36.3%) 和ICU死亡率 (38.4%与49.6%) 相关联.
- 与适当的EAT相比,COI患者不适当的EAT与更糟糕的结果有关.
结论:
- 患有流行性病毒性肺炎和没有细菌共同感染的危急病患者的EAT并没有改善结果.
- 适当的EAT,以微生物学确认为指导,与细菌共感染患者的更好的结果有关.
- 这些发现支持基于诊断和管理原则的有针对性的抗生素策略,而不是常规的经验使用.
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