未经授权:围手术期,经验性抗生素升级治疗并不少见,导致术后住院时间更长,医疗费用更高。然而,很少有系统的研究来研究这个问题。在这项病例对照研究中,我们探讨了影响住院期间微创肺手术后经验性抗生素升级治疗的因素,目的是促进术后恢复和合理使用抗生素。
UNASSIGNED:从医院信息系统(HIS)收集了2019年1月至2020年12月在我们中心接受微创肺手术的患者的数据。根据纳入和排除标准共确定了1,360例。这些患者被分为两组:A组(n=825),其中患者在手术后未接受抗生素升级治疗;B组(n=535),其中患者在手术后接受经验性抗生素升级治疗。采用logistic回归模型分析术后抗菌药物经验性治疗升级的影响因素。
UNASSIGNED:与A组相比,B组术后住院时间明显延长(5.05±2.78vs.4.49±2.24天,P<0.001),平均总住院费用略高(74,080.85±23,796.51vs.71,798.09±21,307.26元,P=0.067)。多因素分析显示,有统计学意义的因素包括二次肺手术史[比值比(OR):3.267;95%置信区间(CI):1.305-8.178;P=0.011]。术前血红蛋白A1c(HbA1c)≥6.5%(OR:1.603;95%CI:1.143-2.249;P=0.006),术后不明原因发热[体温(T)>38℃;OR:2.494;95%CI:1.321-4.708;P=0.005],术后低蛋白血症(静脉白蛋白给药≥2天;OR:14.125;95%CI:1.777-112.282;P=0.012).
UNASSIGNED:多因素分析显示,二次肺手术史,术前HbA1c≥6.5%,术后不明原因发热(T>38℃),术后低蛋白血症(<35g/L和静脉白蛋白给药≥2天)是微创肺手术后经验性抗生素升级治疗的独立危险因素.对于术前风险因素,应开展进一步的队列研究,以探索更好的干预指标或措施.对于术后危险因素,围术期动态监测降钙素原,可指导抗菌药物的合理使用,降低耐药风险和住院费用。
UNASSIGNED: During the perioperative period, empiric antibiotic escalation therapy is not uncommon, leading to longer postoperative hospital stay and higher medical expenses. However, few systematic studies have investigated this issue. In this case-control study, we explored the factors affecting empiric antibiotic escalation therapy after minimally invasive lung surgery during hospitalization, with the aim to enhance recovery after surgery and rational use of antibiotics.
UNASSIGNED: The data of patients who underwent minimally invasive lung surgery at our center from January 2019 to December 2020 were collected from the hospital information system (HIS). A total of 1,360 cases were identified based on the inclusion and exclusion criteria. These patients were divided into 2 groups: group A (n=825), in which patients did not receive antibiotic escalation therapy after surgery; and group B (n=535), in which patients received empiric antibiotic escalation therapy after surgery. A logistic regression model was used to analyze the influencing factors of empiric antibiotherapy escalation during postoperative hospitalization.
UNASSIGNED: Compared with group A, group B had significantly longer postoperative hospital stay (5.05±2.78 vs. 4.49±2.24 days, P<0.001) and slightly higher average total hospitalization costs (74,080.85±23,796.51 vs. 71,798.09±21,307.26 yuan, P=0.067). Multivariate analysis showed that the statistically significant factors included history of secondary lung surgery [odds ratio (OR): 3.267; 95% confidence interval (CI): 1.305-8.178; P=0.011], preoperative hemoglobin A1c (HbA1c) ≥6.5% (OR: 1.603; 95% CI: 1.143-2.249; P=0.006), postoperative fever of unknown origin [temperature (T) >38 ℃; OR: 2.494; 95% CI: 1.321-4.708; P=0.005], postoperative hypoalbuminemia (intravenous albumin administration for ≥2 days; OR: 14.125; 95% CI: 1.777-112.282; P=0.012).
UNASSIGNED: Multivariate analysis showed that history of secondary lung surgery, preoperative HbA1c ≥6.5%, postoperative fever of unknown origin (T >38 ℃), and postoperative hypoalbuminemia (<35 g/L and intravenous albumin administration ≥2 days) were the independent risk factors for empiric antibiotic escalation therapy after minimally invasive lung surgery. For preoperative risk factors, further cohort studies should be conducted to explore better intervention indicators or measures. For postoperative risk factors, perioperative dynamic monitoring of procalcitonin can guide the rational use of antibiotics, reduce the risk of drug resistance and hospitalization cost.