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首页> 外文期刊>Infectious Diseases and Therapy >Antimicrobial Stewardship Opportunities in Critically Ill Patients with Gram-Negative Lower Respiratory Tract Infections: A Multicenter Cross-Sectional Analysis
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Antimicrobial Stewardship Opportunities in Critically Ill Patients with Gram-Negative Lower Respiratory Tract Infections: A Multicenter Cross-Sectional Analysis

机译：革兰氏阴性下呼吸道感染的重症患者的抗菌药物管理机会：多中心跨部门分析

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IntroductionLower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs). MethodsThis was a retrospective, observational, cross-sectional study of adult patients treated in ICUs at two large academic medical centers in metropolitan Detroit, Michigan, from October 2013 to October 2015. To meet the inclusion criteria, patients must have had CDC-defined LRTI caused by a GN pathogen during ICU stay. Microbiological assessment of available Pseudomonas aeruginosa isolates included minimum inhibitory concentrations for key antimicrobial agents. ResultsFour hundred and seventy-two patients, primarily from the community (346, 73.3%), were treated in medical ICUs (272, 57.6%). Clinically defined pneumonia was common (264, 55.9%). Six hundred and nineteen GN organisms were identified from index respiratory cultures: P.?aeruginosa was common (224, 36.2%), with 21.6% of these isolates being multidrug resistant. Cefepime (213, 45.1%) and piperacillin/tazobactam (174, 36.8%) were the most frequent empiric GN therapies. Empiric GN therapy was inappropriate in 44.6% of cases. Lack of in vitro susceptibility (80.1%) was the most common reason for inappropriateness. Patients with inappropriate empiric GN therapy had longer overall stay, which translated to a median total cost of care of $79,800 (interquartile range $48,775 to $129,600) versus $68,000 (interquartile range $38,400 to $116,175), p =?0.013. Clinical failure (31.5% vs 30.0%, p =?0.912) and in-hospital all-cause mortality (26.4% vs 25.9%, p =?0.814) were not different. ConclusionDrug-resistant pathogens were frequently found and empiric GN therapy was inappropriate in nearly 50% of cases. Inappropriate therapy led to increased lengths of stay and was associated with higher costs of care.
机译：简介下呼吸道感染（LRTIs）是发病和死亡的主要原因。由于LRTIs定义方式的变化以及耐药性的增加，对于疾病控制和预防中心（CDC）定义的LRTIs当前使用抗菌药物的负担，知识方面存在空白。我们描述了在重症监护病房（ICU）中治疗的革兰氏阴性（GN）LRTI患者的感染特征，抗生素消耗以及临床和经济结果。方法这是一项回顾性，横断面，横断面研究，研究对象是2013年10月至2015年10月在密歇根州底特律市两个大型学术医学中心的ICU中接受治疗的成年患者。为了符合纳入标准，患者必须接受CDC定义的LRTI由ICU住院期间的GN病原体引起。可用的铜绿假单胞菌分离物的微生物学评估包括对关键抗菌剂的最低抑制浓度。结果274例主要来自社区的患者（346，73.3％）在医疗ICU中接受治疗（272，57.6％）。临床上定义为肺炎是常见的（264，55.9％）。从指数呼吸培养物中鉴定出619个GN生物：铜绿假单胞菌很常见（224，36.2％），其中21.6％的分离株具有多重耐药性。头孢吡肟（213，45.1％）和哌拉西林/他唑巴坦（174，36.8％）是最常见的GN经验疗法。经验性GN治疗不适用于44.6％的病例。缺乏体外敏感性（80.1％）是不适当的最常见原因。经验不佳的GN经验疗法的患者总体住院时间更长，这意味着平均总护理费用为$ 79,800（四分位数范围$ 48,775至$ 129,600），而$ 68,000（四分位范围$ 38,400至$ 116,175），p = 0.013。临床失败率（31.5％vs 30.0％，p =？0.912）和医院内全因死亡率（26.4％vs 25.9％，p =？0.814）没有差异。结论在近50％的病例中，经常发现耐药病原体，经验性GN治疗是不合适的。不适当的治疗导致住院时间增加，并带来更高的护理费用。

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