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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 explore the selection of the initial empirical treatment of HCAP in medical institutions. Methods A retrospective analysis of 156 patients with HCAP admitted on January 1, 2014 to December 31, 2014 was divided into quinolone monotherapy group (n = 84) and bi-anti-multi-drug treatment group (n = 72). General information, pneumonia severity (PSI) score, detection rate of multidrug-resistant bacteria, antibiotic replacement rate, mean duration of antibiotic use, average length of stay, and the number of patients using mechanical ventilation were compared between the two groups and transferred to intensive care unit (ICU ) Ratio, 30 d mortality. Results The quinolone monotherapy group consisted of 46 males and 38 females with an age of (59.9 ± 10.9) years and a PSI score of (89.5 ± 22.7) points. Forty-two males and 28 females, with a mean age of 62.2 ± 12.2) years old and PSI score (94.4 ± 23.6). There was no significant difference in sex composition, age and PSI score between the two groups (P> 0.05). The antibiotic use time in quinolone monotherapy group was (14.5 ± 3.7) ) d, which was longer than that of the two groups (12.8 ± 3.8) d (P = 0.005). The detection rates of multidrug-resistant bacteria and the proportion of antibiotics changed in the quinolone monotherapy group were Hospitalization time, the number of patients in use of mechanical ventilation, the rate of ICU transfer, and the 30-day mortality rates were 17.9%, 34.5%, (16.9 ± 3.6) d, 11.9%, 9.5% and 4.8% Group were 15.3%, 22.2%, (17.3 ± 3.9) d, 16.8%, 12.5% and 4.2% respectively. There was no significant difference between the two groups (P> 0.05). Conclusion HCAP patients should not blindly adopt anti-multi-drug antibiotic therapy should be combined with risk factors and local microbiological epidemic characteristics, the use of individualized treatment.