接受连续脏替代疗法的ICU患者的感染和死亡率:一项回顾性队列研究
Danica Quickfall1, Ashley La2, Jennifer Pisano3
1Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, 5841 S Maryland Ave, MC 5100, Chicago, IL, 60637, USA. danica.quickfall@mail.mcgill.ca.
BMC nephrology
|July 2, 2025
概括
接受连续脏替代疗法 (CRRT) 的重症患者面临高水平的多药耐药性感染和死亡率. 了解这些感染模式对于有效治疗和改善结果至关重要.
科学领域:
- 临界护理医学 临界护理医学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 接受连续脏替代疗法 (CRRT) 的重症患者容易发生多药耐药性感染.
- 在CRRT期间改变的药理动力学会导致抗微生物水平不足和治疗失败.
- 关于CRRT患者感染负担和耐药性模式的数据有限.
研究的目的:
- 调查在重症监护病房 (ICU) 中感染的患病率和特征,这些患者接受持续毒性血液透析 (CVVHD).
- 在这个特定的患者群体中识别常见的病原体,抗菌素耐药性模式和死亡率.
主要方法:
- 对接受CVVHD治疗≥48小时的ICU患者进行回顾性队列研究.
- 纳入标准:阳性微生物培养和接受至少一种抗菌药物.
- 收集有关感染源,病原体,耐药性和死亡率的数据.
主要成果:
- 在661名CRRT受试者中,59.6%的受试者具有积极的文化.
- 最常见的感染:呼吸道 (69.0%),皮肤/软组织 (53.8%),腹内感染 (38.8%).
- 在腹内感染 (63.7%) 和血液感染 (57.7%) 中观察到的最高死亡率.
- 普遍存在的耐药病原体包括抗万科素的E. faecium (83.3%) 和抗塞费皮姆的A. baumannii (100%).
- 观察到的耐药性概况与一般ICU趋势有所不同.
结论:
- 在CRRT的ICU患者中,多种耐药性感染和死亡率很高.
- 针对CRRT的抗菌药物管理和量身定制的剂量,可能包括双重经验覆盖,至关重要.
- 改善结果需要解决CRRT患者抗微生物治疗的独特挑战.
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