論文

査読有り 国際誌
2019年3月19日

A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • Takaya Maruyama
  • Takao Fujisawa
  • Tadashi Ishida
  • Akihiro Ito
  • Yoshitaka Oyamada
  • Kazuyuki Fujimoto
  • Masamichi Yoshida
  • Hikaru Maeda
  • Naoyuki Miyashita
  • Hideaki Nagai
  • Yoshifumi Imamura
  • Nobuaki Shime
  • Shoji Suzuki
  • Masaru Amishima
  • Futoshi Higa
  • Hiroyasu Kobayashi
  • Shigeru Suga
  • Kiyoyuki Tsutsui
  • Shigeru Kohno
  • Veronica Brito
  • Michael S Niederman
  • 全て表示

68
7
開始ページ
1080
終了ページ
1088
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1093/cid/ciy631

BACKGROUND: Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition. METHODS: We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP). RESULTS: Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0-1 MDR risk (25.8% vs 5.3%, P < .001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0-1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P < .001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit <30%, malnutrition, dehydration, and chronic liver disease), as well as hypotension and inappropriate therapy were significantly correlated with 30-day mortality, whereas the classification of pneumonia type (VAP, HAP, HCAP, CAP) was not. CONCLUSIONS: Individual MDR risk factors can be used in a unified algorithm to guide and simplify empiric therapy for all pneumonia patients, and were more important than the classification of site of pneumonia acquisition in determining 30-day mortality. CLINICAL TRIALS REGISTRATION: JMA-IIA00146.

リンク情報
DOI
https://doi.org/10.1093/cid/ciy631
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/30084884
ID情報
  • DOI : 10.1093/cid/ciy631
  • ISSN : 1058-4838
  • PubMed ID : 30084884

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