Guideline-based antibiotics and mortality in healthcare-associated pneumonia.
Guideline-based antibiotics and mortality in healthcare-associated pneumonia.
复制标题
基于指南的抗生素和医疗相关性肺炎的死亡率。
DOI：
10.1007/s11606-012-2011-y
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发表时间：
2012
影响因子：
5.7
通讯作者：
Fan,VincentS
中科院分区：
文献类型：
--
作者：
Madaras-Kelly,KarlJ;Remington,RichardE;Sloan,KevinL;Fan,VincentS
背景指南建议使用抗耐甲氧西林金黄色葡萄球菌（MRSA）和铜绿假单胞菌的抗生素治疗医疗相关性肺炎（HCAP）。目前尚不清楚这种疗法是否能改善HCAP. ObjectiveDetermination的结果，如果管理的指南相似的治疗（GST）是与减少30天死亡率为HCAP.DesignMulti-center retrospective study.PropantsThirteenthousand11入院HCAP在六个退伍军人事务部医疗Centers. Interventions每个入院被归类为接受GST，抗MRSA或抗假单胞菌成分的GST，或在住院后48小时内开始的其他非HCAP治疗。使用逻辑回归模型评估30天死亡率与GST之间的关系，该模型包括GST、接受GST的倾向、从对传统上用于治疗社区获得性肺炎的抗生素耐药的培养物中回收微生物的概率（CAP-电阻），主要指标比值比和95%置信区间[OR（95%CI）]为30- 40。GST治疗患者的30天死亡率和预测的CAP耐药菌恢复概率，以及CAP-耐药概率相互作用治疗的比值比[ROR（95%CI）]。Key ResultsGST治疗与30天死亡率增加相关[OR = 2.11（1.11，4.04），P= 0.02）]，以及CAP耐药微生物恢复的预测概率[OR = 1.67（1.26，2.20），P< 0.001，概率增加25%]。预测的CAP耐药菌恢复概率和GST治疗之间的相互作用表明，在CAP耐药概率高的情况下，GST治疗的死亡率较低[ROR = 0.71（≤1.00），概率增加25%，P= 0.05]。在选择HCAP治疗时，应考虑CAP耐药微生物的患者特定风险的大小。
BackgroundGuidelines recommend administration of antibiotics with activity against methicillin-resistantStaphylococcus aureus(MRSA) andPseudomonas aeruginosafor treatment of healthcare-associated pneumonia (HCAP). It is unclear if this therapy improves outcomes for patients with HCAP.ObjectiveTo determine if administration of guideline-similar therapy (GST) was associated with a reduction in 30-day mortality for HCAP.DesignMulti-center retrospective study.ParticipantsThirteen hundred and eleven admissions for HCAP in six Veterans Affairs Medical Centers.InterventionsEach admission was classified as receiving GST, anti-MRSA or anti-pseudomonal components of GST, or other non-HCAP therapy initiated within 48 hours of hospitalization. Association between 30-day mortality and GST was estimated with a logistic regression model that included GST, propensity to receive GST, probability of recovering an organism from culture resistant to antibiotics traditionally used to treat community-acquired pneumonia (CAP-resistance), and a GST by CAP-resistance probability interaction.Main MeasuresOdds ratios and 95% confidence intervals [OR (95% CI)] of 30-day mortality for patients treated with GST and predicted probability of recovering a CAP-resistant organism, and ratio of odds ratios [ROR (95% CI)] for treatment by CAP-resistance probability interaction.Key ResultsReceipt of GST was associated with increased odds of 30-day mortality [OR = 2.11 (1.11, 4.04),P= 0.02)] as was the predicted probability of recovering a CAP-resistant organism [OR = 1.67 (1.26, 2.20),P< 0.001 for a 25% increase in probability]. An interaction between predicted probability of recovering a CAP-resistant organism and receipt of GST demonstrated lower mortality with GST at high probability of CAP resistance [ROR = 0.71(≤1.00) for a 25% increase in probability,P= 0.05].ConclusionsFor HCAP patients with high probability of CAP-resistant organisms, GST was associated with lower mortality. Consideration of the magnitude of patient-specific risk for CAP-resistant organisms should be considered when selecting HCAP therapy.