【摘要】：目的探討抗菌藥物降階梯療法對肺炎患者臨床結局的影響,為臨床治療提供參考依據(jù)。方法檢索數(shù)據(jù)庫收集2016年6月之前發(fā)表的所有相關研究,共納入13篇研究,研究對象共計4 768例,包括抗菌藥物降階梯組1 221例和持續(xù)性經(jīng)驗抗菌藥物組3547例;采用Stata 12.0軟件進行異質性檢驗、計算RR值及其95%CI可信區(qū)間。結果與持續(xù)性經(jīng)驗抗菌藥物治療比較,抗菌藥物降階梯組可降低肺炎患者的病死率,且差異有統(tǒng)計學意義(P0.01),尤其是在呼吸機相關肺炎和社區(qū)獲得性肺炎患者中差異顯著;而包含兩項隨機對照試驗研究的匯總分析則顯示,抗菌藥物降階梯治療增加肺炎患者的病死率,但差異無統(tǒng)計學意義。結論與持續(xù)性經(jīng)驗抗菌藥物治療比較,抗菌藥物降階梯療法可降低呼吸機相關肺炎和社區(qū)獲得性肺炎患者病死率;但仍需要精心設計的隨機對照試驗評估抗菌藥物降階梯療法對細菌生態(tài)系統(tǒng)、多藥耐藥情況以及患者臨床結局的影響。
[Abstract]:Objective to investigate the effect of antibacterials descending ladder therapy on the clinical outcome of patients with pneumonia and to provide reference for clinical treatment. Methods all the related studies published before June 2016 were collected and 13 studies were included in the database. A total of 4 768 subjects were included in the study, including 1 221 cases in the antibacterials descending ladder group and 3547 cases in the persistent experience group. Stata 12.0 software was used to test the heterogeneity, and the RR value and its 95%CI confidence interval were calculated. Results compared with the continuous experience antibiotic therapy, the mortality of pneumonia patients was significantly decreased in the antibacterials descending ladder group (P0.01), and there was no significant difference between the two groups (P0.01). There was significant difference between ventilator-associated pneumonia and community-acquired pneumonia. The summary analysis including two randomized controlled trials showed that the mortality of pneumonia patients was increased by the step down treatment of antimicrobial agents, but the difference was not statistically significant. Conclusion compared with the continuous experience of antimicrobial therapy, the mortality of patients with ventilator-associated pneumonia and community-acquired pneumonia can be reduced by the step therapy of antimicrobial agents. However, carefully designed randomized controlled trials are still needed to assess the impact of antibacteriological ladder therapy on bacterial ecosystems, multidrug resistance and clinical outcomes.
【作者單位】： 常州市第四人民醫(yī)院感染管理科;常州市第四人民醫(yī)院藥劑科;常州市第四人民醫(yī)院呼吸內科;
【基金】：江蘇省常州四藥臨床藥學科研基金資助項目(2015277)
【分類號】：R563.1

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