课件：杭州肺炎指南会.ppt

Module 2: HAP - New * The prompt administration ofantibiotic therapy is one of the major considerations in providing adequate initial antimicrobial treatment. In a prospective cohort study of 107 consecutive patients receiving mechanical ventilation and antibiotic therapy for VAP, Iregui and coworkers found that 30.8% (33 of 107) received antibiotic treatment that was delayed for at least 24 hours. Of these, 75.8% (25 of 33) received IDAAT due to a delay in writing the antibiotic order.1 Hospital mortality rates were significantly higher in patients with IDAAT (69.7%) compared with those patients without (28.4%) (P0.01). The authors found that IDAAT was an independent predictor of hospital mortality in patients with VAP (P0.001).1 A retrospective study of a national random sample of 18,209 Medicare patients older than 65 years hospitalized with community-acquired pneumonia from July 1998 through March 1999 was performed. Among the 13,771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%), lower mortality within 30 days of admission (11.6% vs 12.7%), and shorter length of stay exceeding the 5-day median (42.1% vs 45.1%). Mean length of stay was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. The authors concluded that antibiotic administration within 4 hours in patients with CAP can prevent deaths in the Medicare population, reduce hospital costs, and is feasible for most inpatients.2 References: 1. Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122:262–268. 2. Houck P et al. Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-Acquired Pneumonia. Arch Intern Med. 2004;164:637–644. Iregui 2