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【Lancet】指南也要灵活运用——医院获得性肺炎

Do Guidelines for Hospital-Acquired Pneumonia Worsen Outcome?

Among intensive care unit patients with pneumonia and risk factors for a multidrug-resistant pathogen, guideline-compliant treatment was associated with increased mortality.

Today's focus on evidence-based medicine has increased the emphasis on developing and following clinical practice guidelines — sometimes even when supporting data are limited. In 2005, the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) jointly released guidelines for the management of hospital-acquired pneumonia (HAP). Now, in a prospective, industry-supported, multicenter trial, investigators have examined whether compliance with these guidelines improves outcomes among intensive care unit patients with pneumonia potentially caused by multidrug-resistant organisms.

During the 18-month study, 413 adult patients were assessed, and 303 met inclusion criteria. Of these patients, 129 received guideline-compliant empirical treatment (2 agents effective against gram-negative pathogens and coverage for methicillin-resistant Staphylococcus aureus), and 174 received a regimen that was noncompliant (most often because of single — rather than dual — gram-negative coverage).

The 28-day mortality rate was higher for the patients who received a guideline-compliant empirical regimen than for those who received a noncompliant regimen (34% vs. 20%; hazard ratio, 1.89; 95% confidence interval, 1.21–2.95). Patients who received guideline-compliant treatment were more likely to have severe sepsis, had a slightly higher mean APACHE II score, and were more likely to have Pseudomonas aeruginosa isolated as a pathogen, but the increased mortality risk appeared to be independent of these factors.

Citations:
Kett DH et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: An observational, multicentre cohort study. Lancet Infect Dis 2011 Jan 20; [e-pub ahead of print]. (http://viajwat.ch/ehkpLC)

Ewig S. Nosocomial pneumonia: De-escalation is what matters. Lancet Infect Dis 2011 Jan 20; [e-pub ahead of print]. (http://dx.doi.org/10.1016/S1473-3099(11)70003-2) 生命科学研究快报文件类型:DOC/Microsoft Word- 文字版生命科学研究快报 2005年第23期(总第86期) (仅供内部参考) 禽流感特辑 (8) 中国科学... 疫情防治和科研进展 骆驼抗体激发灵感科学家建议纳米抗体药物治疗禽流感 我国研制成...www.library.sh.cn/...05/86.doc-2010-11-02-生命科学研究快报" 西京医院门诊部-预约挂号系统抗菌药物管理和干预提供了科学依据,较好地保障了我院临床药物治疗水平和医院医疗质量... 合并病毒性肺炎时肺组织中亦可分离出该病毒.3.血清学检查:动态检测血清甲型H1N1流...www.83215321.com/...type=xinxi-2011-02-06-快照-医院门诊部-预约挂号系统" 晚期乳腺癌的化学治疗及研究进展中国医学科学院药物研究所与江苏恒瑞医药公司合作开发成功后,多西他赛原料药及粉针剂... 以减少并发症发生,可提高手术成功率. 放疗诱发放射性肺炎 乳腺癌在接受放射治疗时可...cotmail.spaces.live.com/...art-2004-03-27-快照-治疗及研究进展"[标签:content2]

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作者:admin@医学,生命科学    2011-02-15 00:42
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