格拉姆阴性血流感染:我们在哪里可以做得更好? 一个回顾性队列研究
Manouc Guit1,2, Konstantin Tanida1,2, Nicole Degel-Brossmann1
1Center for Diagnostics, Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
格兰氏阴性血流感染 (GN-BSI) 的现实管理往往没有达到降级和口服的指导方针. 简单的GN-BSI需要抗生素管理,而复杂的GN-BSI需要个性化策略.
科学领域:
- 传染性疾病 传染性疾病
- 医院流行病学 医院流行病学
- 抗微生物药物管理委员会
背景情况:
- 格拉姆阴性血流感染 (GN-BSI) 是导致入院的重要原因,并带来了重大的临床挑战.
- 目前的指导方针建议降级,口服和适当的治疗持续时间GN-BSI,但现实世界的坚持没有得到充分记录.
研究的目的:
- 评估在第三级护理机构中遵守GN-BSI管理指南.
- 通过延迟或不适当的频谱选择来确定与非最佳抗生素治疗相关的风险因素.
主要方法:
- 在2022年1月至12月期间,对194名GN-BSI患者进行了回顾性观察研究.
- 病例被分为不复杂的 (uGN-BSI) 或复杂的 (cGN-BSI),并分析了治疗开始,降级和口服时间相对于敏感性结果.
主要成果:
- 非最佳治疗率很高,只有22.8%的GUN-BSI和26.9%的cGN-BSI在24小时内获得最佳治疗.
- 在GN-BSI (76.2%) 与cGN-BSI (55.9%) 相比,错过口述的机会更频繁.
- 第三代素耐药性和AmpC生成分离物与低于最佳治疗水平的风险有关.
结论:
- 目前的GN-BSI管理实践经常偏离既定的指导方针,特别是关于抗生素降级和口服.
- 没有并发症的GN-BSI可以从增强的抗生素管理计划中受益.
- 复杂的GN-BSI需要定制的管理策略,可能包括传染病咨询.
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