呼吸机相关的肺炎:多长时间足够长?
Despoina Koulenti1,2,3,4, Maria-Panagiota Almyroudi5, Antonios Katsounas6
1Critical Care Department, King's College Hospital, NHS Foundation Trust, London, United Kingdom.
Current opinion in critical care
|July 7, 2025
概括
在大多数患者中,建议使用较短的抗生素疗程 (7-8天) 来治疗与呼吸机相关的肺炎 (VAP). 这种方法可以减少毒性和耐药性,而不会损害结果,尽管对于复杂的病例和耐药性病原体存在例外.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 抗微生物药物管理委员会
背景情况:
- 呼吸机相关肺炎 (VAP) 是一个主要的ICU感染,具有显著的发病率和抗菌药物的使用.
- 长时间的抗生素疗程 (10-14天) 从历史上来看是标准的,特别是对于多抗药性 (MDR) 或广泛抗药性 (XDR) 生物体.
研究的目的:
- 为提供VAP最佳抗生素持续时间的最新概述.
- 整合指南建议,临床证据和专家意见,以确定VAP治疗的持续时间.
主要方法:
- 对指导方针建议的审查.
- 从随机对照试验,回顾性研究和元分析中综合临床证据.
- 包含关于VAP管理的专家意见.
主要成果:
- 证据支持免疫能力较强的VAP患者使用较短的抗生素疗程 (≤7-8天),降低毒性和耐药性而不会影响结果.
- 最近使用新药的试验往往超过7天,这反映了耐药性病原体和试验设计的挑战.
- 准则的趋同有利于7-8天的VAP治疗,除了特定的病原体,细菌病或缓慢的临床反应.
结论:
- 较短的抗生素疗程 (≤7-8天) 越来越多地支持VAP,强调临床反应和个性化.
- 对于特定的病原体 (MDR/XDR生物体,非发酵物),细菌病和结构性肺部疾病,需要对更短的疗程做出例外.
- 对免疫功能低下的患者和超短VAP疗程需要进一步的研究,而生物标志物则需要VAP特定的验证.
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