在重症监护环境中对结核病的药物管理:一项国际多中心研究
S Tiberi1, O Akkerman2, G Sotgiu3
1Division of Infection, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom;, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK.
概括
在重症监护室 (ICU) 结核病患者的死亡率很高. 静脉注射 (IV) 抗结核病药物,特别是IV 利芬素,可能会改善结核病的结果,因此需要进一步研究优化管理策略.
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
- 肺部病理学 肺部病理学
背景情况:
- 被送往重症监护室 (ICU) 的结核病患者呈现复杂的临床状况,并面临高死亡率.
- 对于ICU中的结核病患者的最佳管理策略仍然不太了解,这突出了重大知识差距.
研究的目的:
- 为了评估结核病患者进入ICU的治疗结果.
- 探索静脉注射 (IV) 抗结核治疗方案的潜在益处.
主要方法:
- 一项回顾性,多中心的观察性研究,涉及434名结核病患者 (>15年) 在2005年至2018年期间在欧洲,亚洲和拉丁美洲接受了ICU治疗.
- 数据收集包括人口统计,微生物学,临床细节和治疗结果.
- 分析的重点是死亡率,治疗成功率和IV抗结核病药物管理的影响.
主要成果:
- 总体死亡率为54.8%,只有33.4%的人获得治疗成功.
- 静脉注射的抗结核病药物给了43%的患者,其中列沃素和阿米卡是最常见的.
- 长时间的静脉注射治疗 (>10天) 和静脉注射里法素的使用与死亡率降低有关 (35.7%与51.7%,p=0.05).
结论:
- 高死亡率强调需要改善结核病患者的ICU管理协议.
- 静脉注射的抗结核病药物,特别是静脉注射的利芬素,在改善结核病结果方面表现有前途.
- 建议进行进一步的前性研究和使用标准化方案进行早期查,以提高高发病率环境中的患者存活率.
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