有效的抗菌药物治疗对呼吸机相关性肺炎感染参数变化的影响

Resolution of Infectious Parameters after Antimicrobial Therapy in Patients with Ventilator Associated Pneumonia

目的 本文对呼吸机相关性肺炎(VAP)给予合适、有效的抗菌药物治疗后临床情况和微生物学的变化进行研究分析。方法 前瞻性研究了23例呼吸机相关性肺炎(VAP)患者的感染参数即最高体温(肛温),外周血WBC计数,人工气道支气管深部分泌物定量培养菌落数(ETA-QC)的变化;最初经验性抗菌药物治疗由经治医生决定,根据培养及药敏结果调整治疗;对呼吸机相关性肺炎(VAP)的感染参数加以评价。结果 VAP的各种感染参数随着时间的变化而逐渐改善,各个感染参数“正常”的时间:菌落数参数“正常”的平均时间为9.78天,95％可信区间值为9.78±1.40天;体温参数“正常”的平均时间为7.42天,95％可信区间值为7.42±1.66天;白细胞数参数“正常”的平均时间为8.75天,95％可信区间值为8.75±1.94天;VAP感染参数“正常”是慢的,通常需要9天。结论 对敏感菌所致的呼吸机相关性肺炎(VAP),应用有效、合适的抗菌药物治疗可采用短程疗法,能够减少耐药菌株的出现引起的二重感染,减少药物的副作用和减轻患者的经济负担。

Objective To describe the clinical and microbiological response to appropriate antimicrobial therapy in patients with ventilator associated pneumonia(VAP) .Methods A prospective study in 23 patients with VAP was conducted changes of infectious parameters (highest temperaturer, leukocyte count in peripheral blood, quantitative culture result of endotracheal aspirate) after antimicrobial therapy in patients. Empirical antimicrobial therapy was given according to the attending physician and modified according to the results of culture and sensitivity. The outcomes of infectious parameters in patients with VAP were assessed. Results All three parameters of infection improved significantly with time. The mean duration to resolution of parameters of number of cfu/ml, temperaturer, leukocyte count was 9.78d,7.42d, 8.75d, respectively. 95 % confidence interval ( CI): 9.78 ± 1.40d, 7.42 ± 1.66d, 8.75± 1.94d, respectively. The mean duration to complete resolution of all parameters was 9d. Conclusion A shorter duration of therapy would reduce the super-infection, antimicrobial resistance, the risks of adverse drugs events and health care costs.