Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
Combination antibiotic therapy with macrolides improves survival in intubated patients with community-acquired pneumonia
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DOI：
10.1007/s00134-009-1730-y
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发表时间：
2010-04-01
影响因子：
38.9
通讯作者：
Rello, J.
中科院分区：
文献类型：
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作者：
Martin-Loeches, I.;Lisboa, T.;Rello, J.
目的：评价大环内酯类药物或氟喹诺酮类药物对重症社区获得性肺炎（severe CAP）重症监护病房（ICU）插管患者生存的影响。前瞻性、观察队列、多中心研究在9个欧洲国家的27个icu中进行。连续纳入218例需要有创机械通气进行CAP入院诊断的患者。165例（75.7%）患者出现严重脓毒症和感染性休克。102例（46.8%）患者获得微生物学记录。ICU死亡率为37.6% （n = 82）。非幸存者年龄较大（58.6 +/- A 16.1岁比63.4 +/- A 16.7岁，P < 0.05），入院时简化急性生理评分II评分较高（45.6 +/- A 15.4岁比50.8 +/- A 17.5岁，P < 0.05）。单药治疗43例（19.7%），联合治疗175例（80.3%）。100例（45.9%）患者的经验性抗生素治疗符合2007年美国传染病学会(IDSA)/美国胸科学会（ATS）指南（大环内酯类46例，氟喹诺酮类54例）。在该队列中，经严重程度调整的Cox回归分析发现，与氟喹诺酮类药物相比，大环内酯类药物的使用与较低的ICU死亡率相关（风险比，HR 0.48，可信区间，95% CI 0.23-0.97, P = 0.04）。对出现严重脓毒症和脓毒性休克的重症患者进行分析（n = 92），结果相似（HR 0.44, 95% CI 0.20 ~ 0.95, P = 0.03）。严重社区获得性肺炎患者对2007年IDSA/ATS指南的依从性较低。重症CAP插管患者应首选大环内酯类药物联合治疗。
To assess the effect on survival of macrolides or fluoroquinolones in intubated patients admitted to the intensive care unit (ICU) with severe community-acquired pneumonia (severe CAP).Prospective, observational cohort, multicenter study conducted in 27 ICUs of 9 European countries. Two hundred eighteen consecutive patients requiring invasive mechanical ventilation for an admission diagnosis of CAP were recruited.Severe sepsis and septic shock were present in 165 (75.7%) patients. Microbiological documentation was obtained in 102 (46.8%) patients. ICU mortality was 37.6% (n = 82). Non-survivors were older (58.6 +/- A 16.1 vs. 63.4 +/- A 16.7 years, P < 0.05) and presented a higher score on the simplified Acute Physiology Score II at admission (45.6 +/- A 15.4 vs. 50.8 +/- A 17.5, P < 0.05). Monotherapy was given in 43 (19.7%) and combination therapy in 175 (80.3%) patients. Empirical antibiotic therapy was in accordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guidelines in 100 (45.9%) patients (macrolides in 46 patients and fluoroquinolones in 54). In this cohort, a Cox regression analysis adjusted by severity identified that macrolide use was associated with lower ICU mortality (hazard ratio, HR 0.48, confidence intervals, 95% CI 0.23-0.97, P = 0.04) when compared to the use of fluoroquinolones. When more severe patients presenting severe sepsis and septic shock were analyzed (n = 92), similar results were obtained (HR 0.44, 95% CI 0.20-0.95, P = 0.03).Patients with severe community-acquired pneumonia had a low adherence with the 2007 IDSA/ATS guidelines. Combination therapy with macrolides should be preferred in intubated patients with severe CAP.