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首页> 外文期刊>PLoS One >Timing of Antimicrobial Therapy after Identification of Ventilator-Associated Condition Is Not Associated with Mortality in Patients with Ventilator-Associated Pneumonia: A Cohort Study
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Timing of Antimicrobial Therapy after Identification of Ventilator-Associated Condition Is Not Associated with Mortality in Patients with Ventilator-Associated Pneumonia: A Cohort Study

机译：呼吸机相关性肺炎患者中确定呼吸机相关疾病后的抗菌治疗时间与死亡率无关：一项队列研究

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Purpose Delays in antimicrobial therapy increase mortality in ventilator-associated pneumonia (VAP). The more objective ventilator-associated complications (VAC) are increasingly used for quality reporting. It is unknown if delays in antimicrobial administration, after patients meet VAC criteria, leads to worse outcomes. Materials and Methods Cohort of 81 episodes of antimicrobial treatment for VAP. We compared mortality, superinfections and treatment failures conditional on the timing of identification of VAC. Results 60% of patients with VAC had an identifiable episode at least 48 before the initiation of antimicrobials. Antimicrobial administration after the identification of VAC was not associated with intensive care unit (ICU) mortality (OR 0.71, 95% CI 0.11–4.48, p = 0.701) compared to immediate antimicrobial administration. Similarly, the risk of treatment failure or superinfection was not affected by the timing of administration of antimicrobials in VAC (HR 0.95, 95% CI 0.42–2.19, p = 0.914). Conclusions We observed no signal of harm associated with the timing to initiate antimicrobials after the identification of a VAC. The identification of VAC should not lead clinicians to start antimicrobials before a diagnosis of VAP can be established.
机译：目的延缓抗菌治疗会增加呼吸机相关性肺炎（VAP）的死亡率。更客观的呼吸机相关并发症（VAC）被越来越多地用于质量报告。在患者达到VAC标准后，延迟抗菌药物给药是否会导致更糟的结果，这是未知的。材料和方法队列81种针对VAP的抗菌治疗。我们根据确定VAC的时间比较了死亡率，重复感染和治疗失败。结果60％的VAC患者在开始使用抗菌药物之前至少有48次出现明显发作。与立即使用抗菌药物相比，确定VAC后进行抗菌药物治疗与重症监护病房（ICU）的死亡率无关（OR 0.71，95％CI 0.11–4.48，p = 0.701）。同样，在VAC中施用抗菌药物的时机也不会影响治疗失败或重复感染的风险（HR 0.95，95％CI 0.42–2.19，p = 0.914）。结论在鉴定VAC后，我们未发现与启动抗菌药物的时间有关的伤害信号。 VAC的确定不应导致临床医生在可以确定VAP的诊断之前就开始使用抗生素。

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