Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia.
Risk factors and antibiotic therapy in P. aeruginosa community-acquired pneumonia.
复制标题
铜绿假单胞菌社区获得性肺炎的危险因素和抗生素治疗。
DOI：
10.1111/resp.12506
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Restrepo,MarcosI
中科院分区：
文献类型：
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作者：
Sibila,Oriol;Laserna,Elena;Maselli,DiegoJose;Fernandez,JuanFelipe;Mortensen,EricM;Anzueto,Antonio;Waterer,Grant;Restrepo,MarcosI
背景与目的目前的指南推荐经验性治疗具有特定危险因素的社区获得性肺炎（CAP）患者中的铜绿假单胞菌。然而，支持这些建议的证据有限。我们评估的危险因素和抗菌治疗的影响，住院的CAP患者由于P. aeruginos.MethodsWe进行了一项回顾性的人口为基础的研究，>150家医院。如果患者被诊断为CAP并且铜绿假单胞菌被确定为致病病原体，则将其纳入研究。单变量和多变量分析进行了使用的危险因素和30天死亡率的依赖measures.Results781例患者与肺炎支原体肺炎被确定在一个队列的62 689例（1.1%）。其中，402例患者（0.6%）被纳入研究，379例（0.5%）因医疗保健相关性肺炎或免疫抑制被排除。在铜绿假单胞菌引起的CAP患者中，272例（67.8%）没有记录的危险因素。这些患者痴呆和脑血管疾病的发病率较高。在出现铜绿假单胞菌的前48小时内对铜绿假单胞菌进行经验性抗生素治疗与铜绿假单胞菌引起的CAP患者30天死亡率较低独立相关（风险比（HR）0.42，95%置信区间（CI）：0.23-0.76）和无铜绿假单胞菌CAP风险因素的患者结论目前指南推荐的危险因素仅能检测到1/3的铜绿假单胞菌所致CAP患者。风险因素并不能定义经验性治疗对铜绿假单胞菌的全部益处。
Background and objectiveCurrent guidelines recommend empirical treatment againstPseudomonas aeruginosain community‐acquired pneumonia (CAP) patients with specific risk factors. However, evidence to support these recommendations is limited. We evaluate the risk factors and the impact of antimicrobial therapy in patients hospitalized with CAP due toP. aeruginosa.MethodsWe performed a retrospective population‐based study of >150 hospitals. Patients were included if they had a diagnosis of CAP andP. aeruginosawas identified as the causative pathogen. Univariate and multivariate analyses were performed using the presence of risk factors and 30‐day mortality as the dependent measures.ResultsSeven hundred eighty‐one patients withP. aeruginosapneumonia were identified in a cohort of 62 689 patients with pneumonia (1.1%). Of these, 402 patients (0.6%) were included in the study and 379 (0.5%) were excluded due to health care‐associated pneumonia or immunosuppression. In patients with CAP due toP. aeruginosa, 272 (67.8%) had no documented risk factors. These patients had higher rates of dementia and cerebrovascular disease. Empirical antibiotic therapy againstP. aeruginosawithin the first 48 h of presentation was independently associated with lower 30‐day mortality in patients with CAP due toP. aeruginosa(hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.23–0.76) and in patients without risk factors forP. aeruginosaCAP (HR 0.40, 95% CI: 0.21–0.76).ConclusionsRisk factor recommended by current guidelines only detect one third of the patients admitted with CAP due toP. aeruginosa. Risk factors did not define the whole benefit observed due to empirical therapy coveringP. aeruginosa.