Severe pneumonia due to Legionella pneumophila:: prognostic factors, impact of delayed appropriate antimicrobial therapy
Severe pneumonia due to Legionella pneumophila:: prognostic factors, impact of delayed appropriate antimicrobial therapy
复制标题
DOI：
10.1007/s00134-002-1304-8
复制
发表时间：
2002-06-01
影响因子：
38.9
通讯作者：
Thomas, R
中科院分区：
文献类型：
--
作者：
Gacouin, A;Le Tulzo, Y;Thomas, R
目的：根据目前文献中报告的预后因素的存在与否以及氟喹诺酮类和大环内酯类药物治疗延迟，比较重度军团菌肺炎（LP）患者的结局。设计：回顾性临床研究。单位：一所大学医院的重症监护室（ICU）。患者：43例既往未接受大环内酯类或氟喹诺酮类药物治疗的连续病例。测量和主要结果：14例（33%）死于LP的患者与29例幸存者进行了比较。38例患者（88%）接受了氟喹诺酮类药物与大环内酯类药物的联合治疗，2例患者单独接受红霉素治疗，3例患者单独接受氧氟沙星治疗。在单变量分析中，SAPS II大于46（p=0.006）和插管要求（p=0.012）与较高的死亡率相关，而在8小时内或到达ICU时给予氟喹诺酮类药物（p=0.011）或红霉素（p=0.044）与较好的生存率相关。通过logistic回归分析，SAPS II评分> 46 [比值比（OR）8.69，95%置信区间（CI）1.15-66.7; p=0.036]，ICU入院前症状持续时间> 5天（OR 7.46;，95%CI 1.17-47.6）是死亡的独立危险因素，到达ICU后8 h内使用氟喹诺酮类药物（OR 0.16- 0.95%，CI 0.03-0.96; P=0.035）与死亡率降低相关。结论：SAPS If评分高于46分，ICU入院前症状持续时间超过5天，插管与死亡率增加相关。在ICU入院后8小时内开始氟喹诺酮类药物治疗可显著降低死亡率。
Objective: To compare the outcome of patients with severe Legionella pneumonia (LP) according to the presence or absence of prognostic factors currently reported in the literature and delays in initiating fluoroquinolones and macrolides. Design: Retrospective clinical investigation. Setting: Intensive care unit (ICU) of an university hospital. Patients: Forty-three consecutive cases with no previous treatment with a macrolide or a fluoroquinolone. Measurements and main results: The 14 (33%) patients who died of LP were compared with the 29 survivors. Thirty-eight patients (88%) received a fluoroquinolone in combination with a macrolide agent, two patients erythromycin alone and three ofloxacin alone. In univariate analysis, SAPS II more than 46 (p=0.006) and intubation requirement (p=0.012) were associated with a higher mortality whereas the administration of fluoroquinolones (p=0.011) or erythromycin (p=0.044) within 8 h or arrival on the ICU was associated with better survival. By logistic regression analysis, SAPS II score more than 46 [odds ratio (OR) 8.69, 95% confidence interval (CI) 1.15-66.7; p=0.036], duration of symptoms prior to ICU admission longer than 5 days (OR 7.46;, 95% CI 1.17-47.6) were independent risk factors for death, Fluoroquinolone administration within 8 h of ICU arrival (OR 0.16-.95%, CI 0.03-0.96; P=0.035) was associated with a reduced mortality. Conclusions: SAPS If score higher than 46, duration of symptoms prior to ICU admission longer than 5 days and intubation were associated with increased mortality. Initiation of fluoroquinolone therapy within 8 h of ICU admission significantly reduced mortality.