急诊肺部感染不恰当初始抗菌治疗的临床分析

Clinical analysis of inappropriate initial antimicrobial therapy in patients with pneumonia in emergency department

目的探讨急诊肺部感染不恰当初始抗菌治疗的现状及其对患者预后的影响。方法对2009年1月至2010年12月急诊收治肺部感染患者的临床资料进行回顾性分析,73例痰培养阳性的肺部感染患者分为恰当治疗组和不恰当治疗组,总结临床特征、病原学特点及预后。结果不恰当治疗组患者的病死率(35.9%)显著高于恰当治疗组患者(14.7%),其平均住院天数(25.1 d)也显著大于后组(19.4 d)。在社区获得性肺炎患者不恰当初始抗菌治疗主要是抗菌药未能覆盖病原菌,在卫生保健相关性肺炎和医院获得性肺炎组主要是病原菌对所选用的抗菌药耐药。结论不恰当抗菌治疗可增加肺部感染患者的病死率和住院天数,根据肺部感染患者的临床诊断、基础疾病、高危因素等结合当地细菌流行病学特点及耐药情况,选择正确的抗菌药物进行恰当的初始抗菌治疗,对改善患者预后有重要意义。

Objective To analyze the profile and prognostic implication of inappropriate initial antimicrobial therapy in patients with pneumonia in emergency department. Methods The clinical data of patients with pneumonia treated in emergency ward from January 2009 to December 2010 were analyzed retrospectively. Seventy-three cases of pneumonia confirmed by positive bacterial culture were assigned to appropriate therapy group or inappropriate therapy group based on their culture result and initial antimicrobial agent. The clinical features, pathogen and outcomes were summarized and compared between groups. Results The mortality of the patients in inappropriate therapy group was significantly higher than that in appropriate therapy group （35.9% vs 17.6%）. The average days of hospital stay of the patients in inappropriate therapy group was significantly longer than that in appropriate therapy group （25.1 vs 19.4 days）. The inappropriate initial antimicrobial therapy in community-acquired pneumonia was mainly due to poor coverage of antimicrobial agents. But in patients with healthcare-associated pneumonia or hospital-acquired pneumonia, the inappropriate initial antimicrobial therapy was mainly due to antibiotic-resistant pathogen. Conclusions Inappropriate initial antimicrobial therapy is associated with higher mortality and longer hospital stay in patients with pneumonia in emergency department. Initial antimicrobial therapy should be selected appropriately based on diagnosis, medical history, risk factors, epidemiology of local pathogens and antibiotic resistance, which may be helpful for improving the prognosis in such patients.