肺炎指南建议对具有特定危险因素的患者进行经验性双重抗伪粒子治疗。然而,对于何时使用双重抗伪粒子治疗缺乏共识,因为建议被认为是弱的,基于低质量的证据。
本研究的目的是开发组合抗生素以评估铜绿假单胞菌的敏感性(P.铜绿假单胞菌)在呼吸道培养中对经验性抗生素的组合使用,并使用组合抗菌图来描述指南推荐双重抗假单胞菌治疗的特定风险因素的影响。
对2014年9月至2018年9月铜绿假单胞菌呼吸道培养阳性的肺炎住院成人进行了回顾性队列研究。收集的数据包括人口统计,抗菌药物敏感性结果,以及指南推荐双重抗伪粒子治疗的危险因素。开发了组合抗生素图,并进行了逻辑回归分析,以确定对β-内酰胺类药物不敏感的危险因素。
纳入了八百十九名患者,72%接受了抗生素治疗。β-内酰胺的敏感性范围为58%至69%,并且添加氟喹诺酮或氨基糖苷导致敏感性的统计学显着增加。然而,仅添加妥布霉素或阿米卡星的敏感率接近或超过90%,按肺炎类型和危险因素分层。基于指南的风险因素的存在通常会导致易感性降低。Logistic回归分析确定了与β-内酰胺类药物不敏感相关的三个危险因素:前90天静脉注射抗生素,养老院住宅,和开始时的机械通气。每个额外风险因素的累积存在影响β-内酰胺敏感率,在没有任何风险因素的情况下为93%,当所有三个风险因素共存时为39%。
肺炎需要双重抗伪粒子治疗的危险因素应进行局部验证。当需要双重抗伪粒子治疗时,妥布霉素或阿米卡星具有提供足够的体外活性的最佳可能性。
Guidelines for pneumonia recommend empiric dual antipseudomonal therapy in patients with specific risk factors. However, there is lack of
consensus on when to use dual antipseudomonal therapy as the recommendations are rated as weak, based on low-quality evidence.
The objectives of this study were to develop combination antibiograms to assess the susceptibility of Pseudomonas aeruginosa (P. aeruginosa) in respiratory cultures to combinations of empiric antibiotics and to use combination antibiograms to delineate the impact of specific risk factors for which
guidelines recommend dual antipseudomonal therapy.
A retrospective cohort study was conducted of adults hospitalized with pneumonia with positive respiratory cultures for P. aeruginosa between September 2014 and September 2018. Data collected included demographics, antimicrobial susceptibility results, and risk factors for which
guidelines recommend dual antipseudomonal therapy. Combination antibiograms were developed and logistic regression was performed to identify risk factors for nonsusceptibility to beta-lactams.
Eight hundred nineteen patients were included and 72% received antibiotics. Beta-lactam susceptibility ranged from 58% to 69% and addition of a fluoroquinolone or aminoglycoside resulted in statistically significant increases in susceptibility. However, only addition of tobramycin or amikacin provided susceptibility rates approaching or exceeding 90% stratified by pneumonia type and risk factors. Presence of
guideline-based risk factors generally resulted in reduced susceptibility rates. Logistic regression identified three risk factors associated with nonsusceptibility to beta-lactams: intravenous antibiotics in the previous 90 days, nursing home residence, and mechanical ventilation at onset. The cumulative presence of each additional risk factor affected beta-lactam susceptibility rates, which were 93% in the absence of any risk factors and 39% when all three risk factors co-existed.
Risk factors necessitating dual antipseudomonal therapy for pneumonia should be locally validated. When dual antipseudomonal therapy is indicated, tobramycin or amikacin have the best likelihood of providing adequate in vitro activity.