呼吸重症监护病房重症下呼吸道感染抗生素降阶梯治疗效价研究

Efficiency and cost of de-escalation antibiotic therapy for severe lower airway infection in RICU

目的评价抗生素降阶梯治疗(de-escalationantibiotictherapy,DEAT)在呼吸重症监护病房(RICU)重症下呼吸道感染(severelowerairwayinfection,SLAI)的意义。方法将我院RICU内机械通气治疗的SLAI患者67例随机分为DEAT组29例,非DEAT组38例。盲取式双套管保护性标本毛刷取下呼吸道分泌物进行病原菌定量培养和涂片,根据病原学结果和临床情况调整抗生素治疗方案。比较两组机械通气(MV)时间、急性生理和慢性健康评价指标Ⅱ(APACHEⅡ)评分、住院时间、临床疗效、抗生素费用、住院总费用等临床资料。结果DEAT组MV时间、住院时间、住院总费用明显低于非DEAT组,分别为(13.5±8.0)天vs(19.1±11.9)天,(21.9±15.7)天vs(31.6±16.2)天,(52871±54457)元vs(82913±49564)元(P<0.05),两组抗生素总费用差异无统计学意义(P>0.05);DEAT组病死率及不适当抗生素治疗(IAT)发生率(13.8%,4/29)低于非DEAT组(36.8%,14/38),差异有统计学意义(P<0.05)。结论抗生素降阶梯治疗明显降低RICU内SLAI的病死率,缩短MV时间、住院时间,降低总住院费用。

Objective To evaluate the efficiency of de-escalation antibiotic therapy （DEAT） in severe lower airway infection（SLAI） patients. Methods Sixty-seven patients with SLAI treated with mechanical ventilator（MV） in the RICU were randomly allocated into two treatment groups：DEAT group 29 cases,and non-DEAT group 38 cases. Sample of lower airway secretion was collected by blinded protected specimen brush（BPSB） to culture and Gram stain, and treatment projects were adjusted according to pathogeny and clinic conditions. The clinical data were compared between DEAT group and non- DEAT group including MV time, acute physiology and chronic health evaluation Ⅱ score,hospitalization time,treatment response and outcome, antibiotic cost, total hospitalization cost, etc. Results DEAT group had less MV time,hospitalization time, and total hospitalization cost than those of non-DEAT group, respectively （13.5±8.0）d vs （19.1±11.9） d,（21.9±15.7） d vs （31.6±16.2） d,（52 871±54 457） ￥ yuan vs （62 913±49 564） ￥yuan（ P 〈0.05）, but antibiotic cost showed no statistic significance（ P〉0.05）. The mortality and inappropriate antibiotic therapy（IAT） rate of DEAT group were lower than those of non-DEAT group significantly （ P〉0.05）. Conclusion The mortality of SLAI significantly was decreased by DEAT. DEAT also led to significantly shorter MV time, shorter course and less total cost of therapy.