机械通风急性脑损伤患者早期抗生素暴露:单中心观察队列研究
Shamsun Sultana1, Anis Chaba2, Adam Jenney3
1Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Australia.
概括
静脉注射抗生素的使用在急性脑损伤 (ABI) 患者中很常见,需要机械通风. 预防性抗生素与改善生存率有关,而治疗性抗生素单独增加了死亡风险.
科学领域:
- 临界护理医学 临界护理医学
- 神经学 神经学
- 传染性疾病 传染性疾病
背景情况:
- 急性脑损伤 (ABI) 经常需要进入重症监护室 (ICU) 和机械通风.
- 机械通风增加了ABI患者医院感染的风险.
- 静脉注射 (IV) 抗生素的使用在这个人群中很普遍,但报告不足.
研究的目的:
- 量化ABI患者在ICU入院14天内对IV抗生素的暴露.
- 描述抗生素使用的类型和持续时间.
- 评估抗生素暴露与30天住院死亡率之间的关联.
主要方法:
- 追溯的,单中心的观察性队列研究.
- 包括接受机械通风的成人ABI患者入住ICU (2018年10月 - 2023年6月).
- 数据收集包括人口统计,临床数据,抗生素暴露,微生物学和结果.
主要成果:
- 在1098名ABI患者中,73%的患者在14天内接受了静脉注射抗生素.
- 塞夫特里亚克松是最常见的治疗抗生素;塞法林用于预防.
- 仅用于预防的抗生素使用与较低的30天死亡率相关 (HR 0.30),而仅用于治疗的使用与增加的死亡率相关 (HR 1.85).
结论:
- 在机械通风的ABI患者中,IV抗生素暴露非常常见.
- 塞夫特里亚克松是常见的一线治疗药物.
- 在调整后的分析中,预防性抗生素的使用显示出显著的生存益处.
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