meta分析关于不适当的抗生素治疗对VAP和血流感染病人死亡率的影响

David

Journal of Critical Care
Volume 23, Issue 1, March 2008, Pages 91-100

Theme Issue Editorial
Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: A meta-analysis
meta分析关于不适当的抗生素治疗对VAP和血流感染病人死亡率的影响
Effie L. Kuti PharmDa, b, Aarti A. Patel PharmD, MBAa, b and Craig I. Coleman PharmD, a, b,  
aUniversity of Connecticut School of Pharmacy, Storrs, CT
bHartford Hospital, Hartford, CT 06102

Available online 20 March 2008.

Abstract
Objectives
Studies have found that initial treatment of ventilator-associated pneumonia (VAP) and blood stream infections (BSI) with inappropriate antimicrobial therapy is associated with higher rates of mortality, but additional studies have failed to confirm this.

Methods
Databases were searched to identify studies that met the following criteria: observational trials, patients with VAP or BSI receiving appropriate and inappropriate antimicrobial therapy, and mortality data. We conducted random-effects model meta-analyses, both with and without adjustment.

Results
Meta-analyses of VAP studies using unadjusted and adjusted data indicated that inappropriate therapy significantly increased patients' odds of mortality (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.51-3.63; P = .0001, I2 = 28.5% and OR, 3.03; 95% CI, 1.12-8.19; P = .0292, I2 = 89.2%, respectively). Meta-analyses of BSI studies using unadjusted and adjusted data showed that inappropriate therapy significantly increased patients' odds of mortality (OR, 2.33; 95% CI, 1.96-2.76; P < .0001, I2 = 48.7% and OR, 2.28; 95% CI, 1.43-3.65; P = .0006, I2 = 88.2%, respectively).

Conclusions
There appears to be an association between initial inappropriate antimicrobial therapy and increased mortality in patients with VAP and BSI.

Keywords: Ventilators; Pneumonia; Bacteremia; Antibiotic

星火

适当抗生素治疗增加增加患VAPand BSI死亡率,一旦患者VAPand BSI,不使用抗菌药是不行的,但使用有增加死亡率?该怎么办?:L :L