The value of routine microbial investigation in ventilator-associated pneumonia
The value of routine microbial investigation in ventilator-associated pneumonia
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DOI：
10.1164/ajrccm.156.1.9607030
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发表时间：
1997-07-01
影响因子：
24.7
通讯作者：
Valles, J
中科院分区：
文献类型：
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作者：
Rello, J;Gallego, M;Valles, J
在113例连续发生呼吸机相关性肺炎（VAP）的成人中，前瞻性研究了常规临床实践中微生物调查的使用、其指导抗生素处方的价值及其对结局的影响。78.7%的病例进行了血培养，95.5%的病例进行了保护性标本刷检，仅45.1%的病例进行了支气管肺泡灌洗。13例（11.5%）未发现致病因子，43例（38.0%）的微生物检测结果指导了治疗的改变。支气管镜检查结果显示27例（23.9%）初始抗生素治疗选择不当，导致抗生素治疗改变。初始选择不充分仍与相关死亡率显著增加相关（37.0%对15.4%，p < 0.05），尽管治疗的改变使这27例发作中的17例（62.9%）临床消退，10例患者存活出院。支气管镜检查结果也允许减少抗生素谱在7个事件（6.1%）。本研究提示，VAP患者的支气管镜检查结果与抗生素治疗的改变密切相关。然而，我们的研究结果也强调了适当的早期抗生素治疗的重要性。
The use of microbiologic investigations in routine clinical practice, their value in guiding antibiotic prescription, and their influence on outcome were prospectively studied in 113 consecutive adults who developed ventilator-associated pneumonia (VAP). Blood cultures were performed in 78.7% of cases, protected specimen brushing in 95.5%, and bronchoalveolar lavage in only 45.1%. No causative agent was identified in 13 episodes (11.5%), and results of microbial tests directed a change in therapy in 43 (38.0%). Bronchoscopic results revealed inadequate initial selection of antibiotic therapy in 27 cases (23.9%) and led to a change in antibiotic treatment. Inadequate initial selection was still associated with a significantly greater increase in related mortality than adequate initial therapy (37.0% versus 15.4%, p < 0.05), although the change in therapy permitted clinical resolution in 17 (62.9%) of these 27 episodes, and 10 patients were discharged alive. Bronchoscopic results also permitted the reduction of the antibiotic spectrum in seven episodes (6.1%). This study suggests that in patients with VAP, bronchoscopic results ape frequently associated with changes in antibiotic therapy, Nevertheless, our findings also emphasize the critical importance of an appropriate early antibiotic therapy.