Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia
Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia
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DOI：
10.1378/chest.122.1.262
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发表时间：
2002-07-01
期刊：
影响因子：
9.6
通讯作者：
Kollef, MH
中科院分区：
文献类型：
--
作者：
Iregui, M;Ward, S;Kollef, MH
研究目的：确定初始延迟适当抗生素治疗（IDAAT）对呼吸机相关性肺炎（VAP）患者预后的影响。环境：圣路易斯Barnes-Jewish Hospital的ICU，这是一所大学附属的城市教学医院。患者：107例连续接受机械通气和抗生素治疗的VAP患者。干预措施：前瞻性患者监测和数据收集。测量和结果：所有107名患者最终都接受了抗生素方案的治疗，该方案在体外显示对从呼吸道分泌物中分离出来的细菌病原体有活性。33例（30.8%）患者在最初满足VAR诊断标准后延迟超过或等于24小时接受抗生素治疗，这些患者被归类为接受IDAAT治疗。使用IDAAT最常见的原因是延误写抗生素单（n = 25; 75.8%）。在接受IDAAT的患者中，从最初满足VAP诊断标准到给予抗生素治疗的平均时间间隔（+/- SD）为28.6 +/- 5.8 h，而所有其他患者为12.5 +/- 4.2 h （p < 0.001）。44例（41.1%）VAP患者在住院期间死亡。通过logistic回归分析，增加APACHE（急性生理和慢性健康评估）11分（校正优势比为1.13,95%可信区间为1.09 ~ 1.18,p < 0.001）、存在恶性肿瘤（校正优势比为3.20,95%可信区间为1.79 ~ 5.71,p = 0.044）和使用IDAAT（校正优势比为7.68,95%可信区间为4.50 ~ 13.09,p < 0.001）被确定为与住院死亡率独立相关的危险因素。结论：这些数据表明，接受IDAAT的患者住院死亡的风险更高。临床医生应避免延迟给VAP患者适当的抗生素治疗，以尽量减少他们的死亡风险。
Study objectives: To determine the influence of initially delayed appropriate antibiotic treatment (IDAAT) on the outcomes of patients with ventilator-associated pneumonia (VAP).Setting: Medical ICU of Barnes-Jewish Hospital, St. Louis, a university-affiliated urban teaching hospital.Patients: One hundred seven consecutive patients receiving mechanical ventilation and antibiotic treatment for VAP.Interventions: Prospective patient surveillance and data collection.Measurements and results: All 107 patients eventually, received treatment with an antibiotic regimen that was shown in vitro to be active against the bacterial pathogens isolated from their respiratory secretions. Thirty-three patients (30.8%) received antibiotic treatment that was delayed for greater than or equal to 24 h after initially meeting diagnostic criteria for VAR These patients were classified as receiving IDAAT. The most common reason for the administration of IDAAT was a delay in writing the antibiotic orders (n = 25; 75.8%). The mean time (+/- SD) interval from initially meeting the diagnostic criteria for VAP until the administration of antibiotic treatment was 28.6 +/- 5.8 h among patients classified as receiving IDAAT, compared to 12.5 +/- 4.2 h for all other patients (p < 0.001). Forty-four patients (41.1%) with VAP died during their hospitalization. Increasing APACHE (acute physiology and chronic health evaluation) 11 scores (adjusted odds ratio, 1.13; 95% confidence interval, 1.09 to 1.18; p < 0.001), presence of malignancy (adjusted odds ratio, 3.20; 95% confidence interval, 1.79 to 5.71; p = 0.044), and the administration of IDAAT (adjusted odds ratio, 7.68; 95% confidence interval, 4.50 to 13.09; p < 0.001) were identified as risk factors independently associated with hospital mortality by logistic regression analysis.Conclusion: These data suggest that patients classified as receiving IDAAT are at greater risk for hospital mortality. Clinicians should avoid delaying the administration of appropriate antibiotic treatment to patients with VAP in order to minimize their risk of mortality.