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早期微生物反应能够预测呼吸机相关肺炎的结局

2021-09-11 小文子 MedSci原创

VAP短期与长期疗效可能与随访微生物培养的重复感染有关

呼吸机相关肺炎(VAP)是危重症患者最常见的医院获得性感染,但现存指南并未明确指出随访微生物培养的指征。近期,发表在European Respiratory Journal杂志的一篇文章评价了诊断VAP 3天后随访微生物培养和微生物学反应预测患者短期和长期疗效的作用。

研究人员对2004年至2017年的前瞻性队列研究进行回顾性分析。呼吸机相关肺炎的诊断是根据临床表现、影像学及微生物学标准。对于微生物鉴定,在诊断时进行气管支气管抽吸,并于72 h后重复,根据两组抽吸物结果定义三组:病原体持续感染、病原体重复感染和病原体根除。

研究纳入157例患者,72小时后,病原体持续感染67例(48%) ,二重感染25例(16%),根除65例(41%)。重症监护室重复感染者死亡率最高(p=0.015),并且90天死亡率最高(p=0.036,同时,未使用呼吸机的天数最少(p=0.024)。多因素分析发现,VAP诊断时出现休克(OR=3.43; 95%CI: 1.259.40),VAP诊断时分离出金黄色葡萄球菌(OR=2.87; 95%CI: 1.067.75)VAP诊断时体温过低(OR=0.67; 95%CI: 0.480.95,每增加1℃)与重复感染有关。

回顾性分析表明,VAP短期和长期疗效可能与随访微生物培养的重复感染有关。随访培养可能有助于指导抗生素治疗及治疗时间,但仍需要进一步前瞻性研究来验证这一发现。

原文出处:

Adrian CeccatoCristina Dominedò, Miquel Ferrer, Ignacio Martin-Loecheset al, Prediction of ventilator-associated pneumonia outcomes according to the early microbiological response: a retrospective observational study, European Respiratory Journal 2021, https://doi.org/10.1183/13993003.00620-2021

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    2021-09-11 八骏奔腾

    `⺍学学学一

    0

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    2021-09-11 查查佳佳

    嗯啦屋企咯把头骷髅精灵

    0

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    2021-09-11 ms1000002136354097

    学习了

    0

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    2021-09-10 14654a1cm82(暂无昵称)

    希望搞临床的医学工作者对人体微生物重视起来,不仅要研究致病菌,更多的要关注非致病菌。

    0

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    2021-09-10 仁术2021

    不错学习了

    0

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    2021-09-09 ms8000001888366461

    学习了

    0

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