抗菌药物的降阶梯策略治疗呼吸机相关性肺炎的Meta分析

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Abstract Objective To systematically evaluate the effect of de-escalation treatment of antibiotic strategy on the patient with ventilator-associated pneumonia (VAP), so as to optimize VAP anti-infective treatment programs and improve prognosis. Methods The relevant literatures published in China and abroad from January 1995 to December 2017 were retrieved from the databases including PubMed, Cochrane library, EMBASE, CBM, CNKI, and Wangfang database by computer. The key words were ventilator-associated pneumonia, antibacterial drugs, antibiotics, target treatment and de-escalation. The Meta-analysis was performed for the eligible literatures with the Review Manager 5.2 software. The effect of step-down treatment on VAP recurrence rate, mechanical ventilation duration, initial treatment reasonable rate, intensive care unit (ICU) hospitalization time and mortality were evaluated. Results A total of 6 articles were included in the study, with 1293 patients involved, including the de-escalation group with 831 cases and the control group with 462 cases. The relapse rate of VAP in de-escalation group was lower than that in control group (RR = 0.52, 95%CI: 0.34, 0.80), while the mechanical ventilation duration of de-escalation group was shorter than that in control group (RR = -7.30, 95%CI: -10.97, -3.64), and the differences were all highly statistically significant (all P ＜ 0.01). However, there were no significant differences in the initial treatment reasonable rate of VAP, ICU hospitalization time, and mortality between the two groups (P ＞ 0.05). Conclusion The de-escalation of antibiotic therapy can decrease the relapse rate of VAP and reduce the mechanical ventilation duration effectively.

Key words： Ventilator-associated pneumonia Antibiotic De-escalation treatment Meta-analysis

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	SUN Jingjing GUO Litao▲ MA Hongye ZHANG Lei LIU Yu WANG Xue

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SUN Jingjing GUO Litao▲ MA Hongye ZHANG Lei LIU Yu WANG Xue. Meta-analysis on the effect of de-escalation of antibiotic treatment on ventilator-associated pneumonia[J]. 中国医药导报, 2019, 16(35): 107-111,115.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I35/107

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