对实证抗生素的临床结果的目标试验仿真在中度免疫功能低下的患者住院治疗肺炎
Louis Saravolatz1, Tejal N Gandhi1, Valerie M Vaughn2,3,4
1Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
概括
在免疫功能低下的肺炎患者中,经验宽谱抗生素没有影响死亡率,但增加了再入院和ICU转移. 这表明,较窄的抗生素谱对这一群体来说可能更安全.
科学领域:
- 传染性疾病 传染性疾病
- 临床医学 临床医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 免疫功能低下的患者经常被排除在肺炎研究和治疗指南之外.
- 这种排除限制了这一脆弱群体在社区获得的肺炎 (CAP) 方面的基于证据的护理.
研究的目的:
- 评估经验宽谱抗生素对CAP中适度免疫受损患者的死亡率和临床结果的影响.
- 评估没有多药耐药生物 (MDROs) 风险因素的患者的结果.
主要方法:
- 一项针对性试验模拟研究在69家医院进行.
- 包括因肺炎住院的中度免疫功能低下患者,但不包括患有MDRO风险因素的患者.
- 对比的是实证广谱抗生素与医院第一或第二天的向抗生素,以死亡率为主要结果.
主要成果:
- 在2706名患者中,59%接受了经验宽谱抗生素;MDROs很少 (3.5%).
- 经验广泛的抗生素使用与死亡率无关.
- 然而,它与增加的30天再入院 (aHR 1.32),ICU转移 (aHR 2.65) 和更长的住院时间 (aRR 1.14) 相联系.
结论:
- 尽管MDRO的发病率很低,但免疫功能低下的肺炎患者经常接受经验广泛的抗生素.
- 这种做法与死亡率的降低无关,但导致了诸如再入院和更长的住院等不良结果.
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