初始抗生素治疗医疗机构相关性肺炎的临床效果比较

Comparison of Clinical Effects between Different Initial Antibiotic Treatments for Health Care-associated Pneumonia

目的探讨医疗机构相关性肺炎(HCAP)的初始经验性治疗方案的选择。方法回顾性分析2014年1月1日-12月31日收治的156例HCAP患者,分为喹诺酮单药治疗组84例和两联抗多重耐药治疗组72例。比较两组患者的一般资料、肺炎严重程度(PSI)评分、多重耐药菌检出率、抗生素更换比例、平均抗生素使用时间、平均住院时间、机械通气使用例数、转入重症监护病房(ICU)比例、30 d病死率。结果喹诺酮单药治疗组男46例,女38例,年龄(59.9±10.9)岁,PSI评分(89.5±22.7)分;两联抗多重耐药治疗组男44例,女28例,年龄(62.2±12.2)岁,PSI评分(94.4±23.6)分,两组患者的性别构成、年龄、PSI评分差异均无统计学意义(P>0.05);喹诺酮单药治疗组抗生素使用时间为(14.5±3.7)d,长于两联抗多重耐药治疗组(12.8±3.8)d,差异有统计学意义(P=0.005);喹诺酮单药治疗组的多重耐药菌检出率、更换抗生素的比例、平均住院时间、机械通气使用例数、转入ICU比例、30 d病死率等分别为17.9%、34.5%、(16.9±3.6)d、11.9%、9.5%、4.8%,两联抗多重耐药治疗组分别为15.3%、22.2%、(17.3±3.9)d、16.8%、12.5%、4.2%,两组指标比较差异均无统计学意义(P>0.05)。结论对于HCAP患者,不应盲目采用抗多重耐药抗菌素治疗,应结合危险因素及当地微生物学流行特征,采用个体化的治疗方案。

Objective To analyze the choice of initial antibiotic treatment for health care-associated pneumonia （HCAP）. Methods A retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1 st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group （group A, n=72） and quinolone monotherapy group （group B, n=84）. The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. Results In group B, there were 46 males and 38 females with the age of （59.9±10.9） years, and the pneumonia severity index （PSI） score was 89.5_＋22.7; in group A, there were 44 males and 28 females with the age of （62.2±12.2） years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant （P 〉 0.05）. The duration of using antibiotics in group B was （14.5±3.7） days, which was longer than that in group A [（12.8±3.8） days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, （16.9±3.6） days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, （17.3±3.9） days, 16.8%, 12.5%, and 4.2%, respectively] （P 〉 0.05）. Conclusions It is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.