The influence of mini-BAL cultures on patient outcomes - Implications for the antibiotic management of ventilator-associated pneumonia
The influence of mini-BAL cultures on patient outcomes - Implications for the antibiotic management of ventilator-associated pneumonia
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DOI：
10.1378/chest.113.2.412
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发表时间：
1998-02-01
期刊：
影响因子：
9.6
通讯作者：
Ward, S
中科院分区：
文献类型：
--
作者：
Kollef, MH;Ward, S
研究目的：确定迷你支气管肺泡灌洗培养结果对抗生素治疗和患者结局后续变化的影响。设计：前瞻性、单中心、队列研究。地点：圣路易斯巴恩斯犹太医院的医学ICU，一所大学附属教学医院。患者：130名机械通气患者因疑似呼吸机相关肺炎（VAP）接受迷你支气管肺泡灌洗。干预措施：微型BAL、前瞻性患者监测和数据收集：测量和结果：60例（46.2%）患者进行了微型BAL培养，这些培养产生了至少一种可能解释临床疑似VAP发作的病原体（64例细菌，3例病毒，2例真菌）。在60例微生物学阳性的微型BAL培养物患者中，44例（73.3%）被归类为接受抗生素治疗不足（即，鉴定出对处方抗生素方案耐药的微生物）。根据mini-BAL培养结果，51例（39.2%）患者的既往抗生素给药或未给药保持不变，而另外51例（39.2%）患者开始抗生素治疗（n=7）或改变现有抗生素治疗方案（n=44），其余28例（21.6%）患者完全停止抗生素治疗。三组的住院死亡率分别为33.3%、60.8%和14.3%，差异有统计学意义（P
Study objective: To determine the influence of mini-BAL culture results on subsequent changes in antibiotic therapy and patient outcomes.Design: Prospective, single-center, cohort study.Setting: Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated teaching hospital.Patients: One hundred thirty mechanically ventilated patients undergoing mini-BAL for suspected ventilator-associated pneumonia (VAP).Interventions: Mini-BAL, prospective patient surveillance, and data collection.Measurements and results: Sixty (46.2%) patients had mini-BAL cultures that yielded at least one pathogen potentially accounting for clinically suspected episode of VAP (64 bacterial, 3 viral, 2 fungal). Among the 60 patients with microbiologically positive mini-BAL cultures, 44 (73.3%) were classified as receiving inadequate antibiotic therapy (ie, identification of a microorganism resistant to the prescribed antibiotic regimen). Prior antibiotic administration or its absence remained unchanged in 51 (39.2%) patients based on the mini-BAL cultures results, while in another 51 (39.2%) patients, antibiotic therapy was either began (n=7) or the existing antibiotic regimen was changed (n=44), and in the remaining 28 (21.6%) patients, antibiotic therapy was discontinued altogether. The hospital mortality rates of these three groups were statistically different: 33.3%, 60.8%, and 14.3%, respectively (p