More Research Is Needed to Quantify Risks, Benefits, and Cost-Effectiveness of Universal Mupirocin Usage.
More Research Is Needed to Quantify Risks, Benefits, and Cost-Effectiveness of Universal Mupirocin Usage.
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需要更多的研究来量化普遍使用莫匹罗星的风险、益处和成本效益。
DOI：
10.1093/cid/ciw077
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Deeny SR
中科院分区：
文献类型：
--
作者：
Deeny SR
致编辑-我们感谢Hurley[1]对我们的研究[2]的关注和评论，以及他对研究的以下方面的观点：死亡率与其他研究相比存在差异，明显的影响仅限于接受机械通风的人，以及无法测量的混杂。Hurley[1]提供的一个例子表明，我们研究中的死亡率明显不同于其他研究，包括小林等人的研究[3]。然而，由于研究设计的不同，这是意料之中的。在不考虑患者年龄、受伤皮肤的大小和深度的情况下，不能在不同研究之间比较烧伤的死亡率[4，5]。我们的研究人群与以前的流行病学报告中描述的人群不同。首先，我们符合条件的患者的平均年龄远远高于小林等人的研究[3](大约60岁对40岁)。第二，我们只选择严重烧伤患者，定义为烧伤指数≥10(烧伤指数=全层总烧伤面积+1/2部分烧伤面积)[4]。就死亡率而言，抗生素预防不会对小面积烧伤(即不太可能导致败血症或器官衰竭)产生效果。在我们的研究中，机械通气组和非机械通气组的平均烧伤指数分别约为37和16[2]。烧伤指数比Kobayashi等[3]的流行病学报告中所描述的严重得多(平均烧伤面积为18.8%；烧伤指数为13.9)。并不是所有有吸入性损伤的烧伤患者都需要机械通气，而一些没有吸入性损伤的患者需要机械通气(例如，顽固性休克或意识障碍或需要大量液体的患者)。我们以前报道过，没有机械通气的吸入性损伤与死亡率之间没有显著的关联，需要机械通风是死亡率的独立预测因子[4]，这与最近的其他研究一致[6，7]。正如Hankovszky等人的社论[8]中提到的那样，由于呼吸机和非呼吸机烧伤患者的死亡率存在巨大差异，将患者按需要机械通风定义的分组明显地按严重程度区分了整个队列。因此，我们推测，需要机械通风的患者的烧伤严重程度可能已经高到足以导致免疫缺陷[9]，这些患者可能在烧伤后早期遭受亚临床感染和败血症[2]。
TO THE EDITOR—We thank Hurley [1] for his interest and comments on our study [2] and for his points regarding the following aspects of the study: mortality difference compared with that of other studies, the apparent effect being limited to those receiving mechanical ventilation, and unmeasured confounding. Hurley [1] presents an illustration that shows that mortality in our study was apparently different from that of other studies, including that of Kobayashi et al [3]. However, this is only to be expected because of the different study designs. Mortalities from burn injuries cannot be compared between studies without taking patient age and size and depth of the injured skin into consideration [4, 5]. Our study population was different from those described in previous epidemiological reports. First, the mean age of our eligible patients was much higher than in the study of Kobayashi et al [3](approximately 60 vs 40 years). Second, we selected only severe burn patients, defined as having a burn index≥ 10 (burn index= full thickness total burn surface area [TBSA]+ 1/2 partial thickness TBSA)[4]. Antibiotic prophylaxis would not be expected to have an effect in small burns (ie, less likely to result in sepsis or organ failure) as far as mortality is concerned. In our study, the mean burn index for mechanically ventilated and nonmechanically ventilated groups was approximately 37 and 16, respectively [2]. The burn index was much more severe than that described in the epidemiological report of Kobayashi et al [3](mean TBSA, 18.8%; burn index, 13.9).Not all burn patients with inhalation injury require mechanical ventilation, while some patients without inhalation injury require mechanical ventilation (eg, patients with refractory shock or impaired consciousness or patients who require a large amount of fluid). We previously reported that there was no significant association between inhalation injury without mechanical ventilation and mortality and that the need for mechanical ventilation was an independent predictor of mortality [4], which is consistent with other recent studies [6, 7]. As mentioned in the editorial by Hankovszky et al [8], because there is a huge difference in mortality between ventilated and nonventilated burns patients, dividing patients into groups defined by need for mechanical ventilation clearly separates the entire cohort by severity. Thus, we speculate that the severity of burns in patients who required mechanical ventilation could have been high enough to induce immune deficiency [9], and such patients may have suffered from subclinical infection and sepsis in the early phase after burn injury [2].
DOI：
10.1073/pnas.0401324101
发表时间：
2004-07-06
影响因子：
11.1
作者：
Cooper, BS;Medley, GF;Ebrahim, S
通讯作者：
Ebrahim, S