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首页> 外文期刊>Infection >Practice patterns for antibiotic de-escalation in culture-negative healthcare-associated pneumonia.
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Practice patterns for antibiotic de-escalation in culture-negative healthcare-associated pneumonia.

机译：培养阴性与医疗保健相关的肺炎中抗生素降级的实践模式。

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BACKGROUND: Published guidelines for the treatment of healthcare-associated pneumonia (HCAP) recommend initial broad-spectrum antibiotics with appropriate de-escalation based on culture results. Guideline recommendations are based on data from intubated patients, in whom cultures are easily obtained. The approach to antibiotic de-escalation for culture-negative patients has not been addressed. Consequently, there are no published reports that describe the current standard of practice. PATIENTS AND METHODS: All patients admitted to a university hospital with a diagnosis of HCAP, as defined by use of a pneumonia orderset, were identified retrospectively over a 2-year period. Antibiotics prescribed on admission, during hospital stay, and on discharge were recorded. De-escalation was defined as a change in the initial antibiotic therapy from broad- to narrow-spectrum coverage within 14 days of the initial prescription. The Pneumonia Severity Index was used for risk-adjustment. RESULTS: A total of 102 patients were included in the analysis; of these, 72% (n = 73) were culture-negative. There were more males in the culture-negative than culture-positive group; otherwise, baseline characteristics were similar. Antibiotic therapy was de-escalated in 75% of the culture-negative group and 77% of the culture-positive group (p = 1.00). Culture-negative patients were de-escalated approximately 1 day earlier than culture-positive patients (3.93 vs. 5.04 days, p = 0.03). Culture-negative patients who were de-escalated had a shorter length of hospitalization, lower hospital costs, and lower mortality rates. In 70% of the culture-negative patients, a respiratory fluoroquinolone was chosen for de-escalation. CONCLUSION: In this single-center study, most of the patients with culture-negative HCAP were safely de-escalated to a respiratory fluoroquinolone.
机译：背景：已发表的治疗与医疗保健相关的肺炎（HCAP）的指南推荐了最初的广谱抗生素，并根据培养结果适当降低了治疗的剂量。指南推荐基于插管患者的数据，这些患者容易获得培养物。培养阴性患者的抗生素降级方法尚未解决。因此，没有公开的报告描述当前的实践标准。患者和方法：回顾性分析在2年的时间里，所有入院医院并诊断为HCAP的患者（定义为使用肺炎命令集）。记录入院时，住院期间和出院时规定的抗生素。降级定义为在初始处方后14天内初始抗生素治疗从广谱到窄谱变化。肺炎严重程度指数用于风险调整。结果：共有102例患者被纳入分析。其中72％（n = 73）为培养阴性。文化阴性组的男性多于文化阳性组。否则，基线特征相似。培养阴性组的75％和培养阳性组的77％降低了抗生素治疗的水平（p = 1.00）。培养阴性患者比培养阳性患者提前约1天降级（3.93比5.04天，p = 0.03）。降低了文化水平的患者的住院时间缩短了，住院费用降低了，死亡率也降低了。在70％培养阴性的患者中，选择呼吸性氟喹诺酮进行降级。结论：在这项单中心研究中，大多数培养阴性的HCAP患者已安全地升级为呼吸道氟喹诺酮。

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