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目的:分析急诊肺部感染不恰当初始抗菌治疗的临床情况。方法:回顾性分析本院2015年11月~2017年3月接收的因不恰当初始抗菌治疗导致治疗失败的急诊肺部感染患者55例的临床资料,分析不恰当初始治疗产生的原因。结果:55例患者住院时间平均(24.8±12.2)d;住院期间,19例患者死亡,死亡率34.5%。HCAP患者中,60.0%因病原菌对所选抗菌药物耐药导致;HAP患者中,81.2%因病原菌对所选抗菌药物耐药所致;CAP患者中,88.9%因抗菌药物未能覆盖病原菌所致。结论:不恰当初始抗菌治疗会导致急诊肺部感染患者住院时间延长,并提高病死率,而病原菌对所选抗菌药物耐药、抗菌药物未能覆盖病原菌为主要造成不恰当治疗的原因,临床制定初始抗菌治疗方案时应密切注意,保证治疗方案制定的科学性及合理性。
OBJECTIVE: To analyze the clinical situation of inappropriate initial antibacterial therapy for emergency lung infections. Methods: The clinical data of 55 patients with emergency pulmonary infection who failed to receive treatment due to inappropriate initial antibacterial treatment received from November 2015 to March 2017 in our hospital were retrospectively analyzed to analyze the causes of inappropriate initial treatment. Results: The average hospitalization time of 55 patients was (24.8 ± 12.2) d. During hospitalization, 19 patients died and the mortality rate was 34.5%. Among the patients with HCAP, 60.0% were resistant to the selected antimicrobial agents due to pathogens; 81.2% of HAP patients were resistant to the selected antimicrobial agents due to pathogens; 88.9% of CAP patients were unable to cover the pathogens due to antibacterials . Conclusion: Inappropriate initial antibacterial treatment can lead to prolonged hospitalization and increased mortality in patients with acute pulmonary infection. However, pathogenic bacteria are resistant to the selected antibacterial drugs and antibacterial drugs can not cover pathogens, which is the main cause of improper treatment. Clinical development The initial antibacterial treatment program should pay close attention to ensure that the treatment plan developed scientific and reasonable.