Empiric Antibiotic Therapy for Pulmonary Infiltrates

肺部浸润的患者接受了ICU处方中一半以上的抗生素。这些患者中有许多因疑似呼吸道感染而接受抗生素治疗，但尚未得到证实。然而，这些x线片异常的患者中，有许多实际上是非感染性病因。尽管肺炎是ICU患者中最常见的医院获得性感染，但由于诊断严重依赖于与临床肺炎相关性较差的x线检查结果，因此很难确诊。但由于院内肺炎的可归因死亡率，错过可治疗感染的风险往往超过最小风险抗生素治疗的看法。因此，在这部分患者中，过度使用或不适当使用抗生素治疗疑似肺炎的情况很普遍，并且由于抗生素过度使用而出现的抗微生物药物耐药性细菌越来越普遍。

Patients with pulmonary infiltrates receive more than half of the antibiotics prescribed in the ICU. Many of these patients receive antibiotics for suspected, but not proven, respiratory infections. Yet many of these patients with abnormal radiographs actually have a non-infectious etiology. Although pneumonia is the most common hospital acquired infection in ICU patients, it is difficult to diagnose definitively because the diagnosis relies heavily on radiographic findings that correlate poorly with clinical pneumonia. But because of the attributable mortality associated with nosocomial pneumonia, the risk of missing a treatable infection often outweighs the perception of minimal risk antibiotic therapy. Consequently, overuse or inappropriate use of antibiotics for the treatment of suspected pneumonia is widespread in this subset of patients, and the emergence of antimicrobial resistant bacteria as a result of antibiotic overuse is increasingly common. This protocol is designed to determine whether short course empiric antibiotic therapy (3 days of meropenem) for patients with new pulmonary infiltrates can reduce the emergence of antimicrobial resistant organisms compared to a standard course of antibiotic therapy (10 days of therapy with antibiotics of the primary care teams choosing). In addition, it will determine whether hospital length of stay can be reduced, hospital cost can be reduced, while morbidity and mortality of patients will not be affected. This protocol targets patients who have new pulmonary infiltrates, yet are at low risk of having pneumonia, as determined using the Clinical Pulmonary Infection score (CPIS). Progress Report: Final approval from the BAMSG Steering Committee has been obtained. The study has undergone scientific review and is pending IRB review at the Clinical Center once ten study sites are identified and approved. Site surveys are being circulated to assess the sites ability to enroll patients.