重癥監(jiān)護(hù)病房鎮(zhèn)靜治療的應(yīng)用

精選課件

1.共同進(jìn)食蔬菜和水果可使孕婦上呼吸道

感染風(fēng)險(xiǎn)降低

【據(jù)《PublicHealthNutr.》2010年2月報(bào)道】題：進(jìn)食蔬菜和水果與孕婦上呼吸道感染風(fēng)險(xiǎn)間的關(guān)系（作者：LiLWerlerMM）美國(guó)波士頓大學(xué)公共衛(wèi)生學(xué)院流行病學(xué)系LiL與WerlerMM開(kāi)展此次研究，旨在評(píng)估在妊娠期間進(jìn)食蔬菜和水果與上呼吸道感染（URTI)）發(fā)生率之間的關(guān)系。研究納入北美婦女1034例，讓其回顧其在妊娠前6個(gè)月進(jìn)食蔬菜和水果與在妊娠前半期時(shí)結(jié)果顯示，攝入總的水果和蔬菜量的最高四分位（中位量8.54servings/d）vs.最低四分位（中位量1.91servings/d）的婦女，在隨訪5個(gè)月時(shí)發(fā)生URTI的校正HR為0.74，隨訪3個(gè)月時(shí)為0.61。在隨訪3個(gè)月時(shí)攝入的水果和蔬菜與URTI風(fēng)險(xiǎn)降低呈劑量相關(guān)，但隨訪5個(gè)月時(shí)無(wú)此相關(guān)性。未發(fā)現(xiàn)單獨(dú)進(jìn)食蔬菜或水果與5個(gè)月或3個(gè)月時(shí)URTI風(fēng)險(xiǎn)的關(guān)系。URTI的發(fā)生率。用Cox比例危害模型計(jì)算多變量校正危害（HR）。精選課件1.共同進(jìn)食蔬菜和水果可使孕婦上呼吸道

感染風(fēng)險(xiǎn)降低

研究表明，婦女進(jìn)食蔬菜和水果較多可中度降低妊娠期間URTI的風(fēng)險(xiǎn)，這種獲益似乎來(lái)源于蔬菜與水果共同進(jìn)食而非單一進(jìn)食。精選課件1.共同進(jìn)食蔬菜和水果可使孕婦上呼吸道

感染風(fēng)險(xiǎn)降低

OBJECTIVE:Thepresentstudyevaluatedtheassociationbetweenfruitandvegetableintakeandtheincidenceofupperrespiratorytractinfection(URTI)duringpregnancy.DESIGN:Inacohortof1034NorthAmericanwomen,eachsubjectwasaskedretrospectivelyabouttheirfruitandvegetableintakeduringthesixmonthsbeforethepregnancyandtheiroccurrencesofURTIduringthefirsthalfofpregnancy.Multivariable-adjustedhazardratios(HR)werecalculatedwithCoxproportionalhazardsmodels.精選課件1.共同進(jìn)食蔬菜和水果可使孕婦上呼吸道

感染風(fēng)險(xiǎn)降低

RESULTS:TheadjustedHRofURTIforwomeninthehighestquartile(median8.54servings/d)v.thelowestquartile(median1.91servings/d)oftotalfruitandvegetableintakewas0.74(95%CI0.53,1.05)forthe5-monthfollow-upperiodand0.61(95%CI0.39,0.97)forthe3-monthfollow-upperiod,respectively.Adose-relatedreductionofURTIriskaccordingtoquartileofintakewasfoundinthe3month(Pfortrend=0.03)butnotthe5-monthfollow-up.Noassociationwasfoundbetweeneitherfruitorvegetableintakealoneinrelationtothe5-monthorthe3-monthriskofURTI.CONCLUSIONS:WomenwhoconsumemorefruitsandvegetableshaveamoderatereductioninriskofURTIduringpregnancy,andthisbenefitappearstobederivedfrombothfruitsandvegetablesinsteadofeitheralone.精選課件2.降鈣素原水平可預(yù)測(cè)社區(qū)獲得性肺炎患者

的菌血癥水平

BACKGROUND:Guidelinesrecommendbloodculturesamplingfromhospitalizedpatientswithsuspectedcommunity-acquiredpneumonia(CAP).However,theyieldoftruepositiveresultsislow.Weinvestigatedthebenefitofprocalcitonin(PCT)onadmissiontopredictbloodculturepositivityinCAP.METHODS:Thisisaprospectivecohortstudywithaderivationandvalidationsetincludingatotalof925CAPpatientswithbloodculturesamplinguponhospitaladmission.RESULTS:Atotalof73patients(7.9%)hadtruebacteremia(43/463inthederivationcohort,30/462inthevalidationcohort).Theareaunderthereceiver-operating-characteristicscurveofPCTinthederivationandvalidationcohortweresimilar(0.83(95%CI0.78-0.89),0.79(95%CI0.72-0.88).Overall,PCTwasasignificantlybetterpredictorforbloodculturepositivityascomparedtowhitebloodcellcount,C-reactiveproteinandotherclinicalparameters.精選課件2.降鈣素原水平可預(yù)測(cè)社區(qū)獲得性肺炎患者

的菌血癥水平Inmultivariateregressionanalysis,onlyantibioticpretreatment(adjustedOR0.25,p<0.05)andPCTserumlevels(adjustedOR3.72,p<0.001)wereindependentpredictors.Overall,aPCTcut-offof0.1mug/Lwouldallowreducingthetotalnumberofbloodculturesby12.6%andstillidentifying99%ofthepositivebloodcultures.Similarly,0.25mug/Land0.5mug/Lcutoffswouldallowreducingbloodculturesby37%and52%andstillidentifying96%and88%ofpositivebloodcultures.CONCLUSION:InitialPCTlevelaccuratelypredictedbloodculturepositivityinCAPpatients.PCTmeasurementhasthepotentialtoreducethenumberofdrawnbloodculturesintheEmergencyDepartmentandtoimplementamoretargetedallocationoflimitedhealthcareresources.精選課件2.降鈣素原水平可預(yù)測(cè)社區(qū)獲得性肺炎患者

的菌血癥水平

據(jù)【《Chest》2010年3月報(bào)道】題：降鈣素原水平可預(yù)測(cè)社區(qū)獲得性肺炎患者的菌血癥水平：一項(xiàng)前瞻性隊(duì)列研究（作者：MüllerF等）指南建議，懷疑患有社區(qū)獲得性肺炎（CAP）的住院患者應(yīng)采集血樣進(jìn)行血培養(yǎng)。然而，血培養(yǎng)結(jié)果的真陽(yáng)性率較低。因此，瑞士Basel大學(xué)醫(yī)院MüllerF等開(kāi)展此前瞻性隊(duì)列研究，旨在探討接診時(shí)血降鈣素原水平用于預(yù)測(cè)CAP患者血培養(yǎng)陽(yáng)性的價(jià)值。該研究共入組了925例懷疑患有CAP的住院患者，入院時(shí)均立即進(jìn)行血培養(yǎng)檢測(cè)血降鈣素原水平。結(jié)果顯示，共73例（7.9%）患者有菌血癥。與白細(xì)胞計(jì)數(shù)、C反應(yīng)蛋白以及其他臨床指標(biāo)相比，降鈣素原水平是一個(gè)更好的血培養(yǎng)陽(yáng)性預(yù)測(cè)因子。多因素回歸分析顯示，只有入院接受治療前應(yīng)用抗菌藥物（校正OR為0.25）和血清降鈣素原水平（校正OR為3.72）為獨(dú)立預(yù)測(cè)因子。精選課件2.降鈣素原水平可預(yù)測(cè)社區(qū)獲得性肺炎患者

的菌血癥水平降鈣素原水平切點(diǎn)為0.1μg/L時(shí)可減少血培養(yǎng)總數(shù)達(dá)12.6%，而且采用此切點(diǎn)仍可發(fā)現(xiàn)99%的陽(yáng)性血培養(yǎng)。當(dāng)降鈣素原水平切點(diǎn)為0.25μg/L和0.5μg/L時(shí)可分別減少血培養(yǎng)總數(shù)37%和52%，而且仍可分別發(fā)現(xiàn)96%和88%的陽(yáng)性血培養(yǎng)。研究表明，初始降鈣素原水平可準(zhǔn)確預(yù)測(cè)社區(qū)獲得性肺炎患者是否血培養(yǎng)陽(yáng)性。檢測(cè)降鈣素原可減少急診采血進(jìn)行血培養(yǎng)的次數(shù)，有利于合理分配有效的醫(yī)療資源。精選課件3.兒童接種肺炎鏈球菌疫苗后急性下呼吸道

感染住院風(fēng)險(xiǎn)增加Background：AustralianIndigenouschildrenaretheonlypopulationworldwidetoreceivethe7-valentpneumococcalconjugatevaccine(7vPCV)at2,4,and6monthsofageandthe23-valentpneumococcalpolysaccharidevaccine(23vPPV)at18monthsofage.Weevaluatedthisprogram'seffectivenessinreducingtheriskofhospitalizationforacutelowerrespiratorytractinfection(ALRI)inNorthernTerritory(NT)Indigenouschildrenaged5-23months.Methods.WeconductedaretrospectivecohortstudyinvolvingallNTIndigenouschildrenbornfrom1April2000through31October2004.Person-timeat-riskafter0,1,2,and3dosesof7vPCVandafter0and1doseof23vPPVandthenumberofALRIfollowingeachdosewereusedtocalculatedose-specificratesofALRIforchildren5-23monthsofage.精選課件RateswerecomparedusingCoxproportionalhazardsmodels,withthenumberofdosesofeachvaccineservingastime-dependentcovariates.Results.Therewere5482childrenand8315child-yearsatrisk,with2174episodesofALRIrequiringhospitalization(overallincidence,261episodesper1000child-yearsatrisk).ElevatedriskofALRIrequiringhospitalizationwasobservedaftereachdoseofthe7vPCVvaccine,comparedwiththatforchildrenwhoreceivednodoses,andanevengreaterelevationinriskwasobservedaftereachdoseofthe23vPPV(adjustedhazardratio[HR]vsnodose,1.39;95%confidenceinterval[CI],1.12-1.71;[Formula:seetext]).Riskwashighestamongchildrenvaccinatedwiththe23vPPVwhohadreceived<3dosesofthe7vPCV(adjustedHR,1.81;95%CI,1.32-2.48).Conclusions.OurresultssuggestanincreasedriskofALRIrequiringhospitalizationafterpneumococcalvaccination,particularlyafterreceiptofthe23vPPVbooster.Theuseofthe23vPPVboostershouldbereevaluated.精選課件【據(jù)《ClinInfectDis.》2010年4月報(bào)道】題：澳大利亞5?23個(gè)月的土著嬰兒在接種肺炎鏈球菌疫苗后因急性下呼吸道感染住院的風(fēng)險(xiǎn)增加：一項(xiàng)隊(duì)列研究（作者：O'GradyKA等）澳大利亞土著兒童是世界范圍內(nèi)唯一在2、4、6個(gè)月接受7價(jià)肺炎鏈球菌結(jié)合疫苗（7vPCV），且在18個(gè)月接受23價(jià)肺炎球菌多糖疫苗（23vPPV）的人群。澳大利亞查爾斯達(dá)爾文大學(xué)O'GradyKA等設(shè)計(jì)了一項(xiàng)回顧性隊(duì)列研究，評(píng)估了此疫苗接種項(xiàng)目在降低北方地區(qū)（NorthernTerritory，NT）5?23個(gè)月土著兒童急性下呼吸道感染（ALRI）住院風(fēng)險(xiǎn)的療效。研究納入于2000年4月1日至2004年10月31日間出生的所有NT土著兒童。應(yīng)用在第0、1、2、3劑接種7vPCV后和第0、1劑接種23vPPV后的危險(xiǎn)人次以及每劑接種后出現(xiàn)ALRI的數(shù)量計(jì)算5?23個(gè)月兒童ALRI的劑量特異性發(fā)生率。結(jié)果顯示，共納入5482名兒童，患病風(fēng)險(xiǎn)為8315兒童-年，共2174次ALRI事件需要住院（總的發(fā)生率，261/1000兒童-年風(fēng)險(xiǎn)）。與未接種疫苗的兒童相比，接種每一劑7vPCV疫苗后的兒童，ALRI需要住院的風(fēng)險(xiǎn)增加，在接種每一劑的23vPPV后，風(fēng)險(xiǎn)增加的似乎更高（與未接種者相比，接種者的校正HR為1.39）。接種23vPPV疫苗同時(shí)接種7vPCV疫苗小于3劑的兒童風(fēng)險(xiǎn)最高（校正HR，1.81）。研究表明，兒童在接種肺炎疫苗后ALRI需住院的風(fēng)險(xiǎn)增加，尤其是在接受23vPPV加強(qiáng)免疫之后。故應(yīng)重新評(píng)估23vPPV加強(qiáng)免疫的療效。精選課件4.住院期間血小板增多或減少可預(yù)測(cè)CAP

患者的死亡率

【據(jù)《Chest》2010年2月報(bào)道】題：住院期間血小板增多或減少可預(yù)測(cè)社區(qū)獲得性肺炎患者死亡率（作者：MirsaeidiM等）血小板屬于炎癥細(xì)胞，在抗微生物宿主防御中起重要作用。據(jù)推測(cè)血小板計(jì)數(shù)異常也許是社區(qū)獲得性肺炎（CAP）患者病情嚴(yán)重的一個(gè)標(biāo)志。美國(guó)路易斯維爾大學(xué)MirsaeidiM等開(kāi)展了一項(xiàng)回顧性隊(duì)列研究，評(píng)估了CAP住院患者異常的血小板計(jì)數(shù)是否與其30天死亡率相關(guān)，并對(duì)血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)作為30天死亡率的預(yù)測(cè)因子進(jìn)行比較。此研究納入500例連續(xù)的CAP患者，調(diào)查血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)與患者30天死亡率的關(guān)系。預(yù)測(cè)變量為血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)。異常血小板計(jì)數(shù)為＜100000/L（血小板減少）和＞400000/L（血小板增多）。結(jié)局變量為30天死亡率。應(yīng)用包括33個(gè)變量的傾向評(píng)分控制潛在混雜因素。結(jié)果顯示，血小板計(jì)數(shù)與30天死亡率強(qiáng)烈相關(guān)（P=0.0009），未發(fā)現(xiàn)白細(xì)胞計(jì)數(shù)與30天死亡率的關(guān)系。高血小板計(jì)數(shù)可致患者死亡率顯著增加。研究表明，血小板增多或減少與住院的CAP患者的死亡率相關(guān)。當(dāng)對(duì)CAP患者進(jìn)行初始CBC檢測(cè)評(píng)估時(shí)，異常的血小板計(jì)數(shù)比異常的白細(xì)胞計(jì)數(shù)更能預(yù)測(cè)患者結(jié)局精選課件BACKGROUND:Plateletsareinflammatorycellswithanimportantroleinantimicrobialhostdefenses.Wespeculatethatanabnormalplateletcountmaybeamarkerofseverityinpatientswithcommunity-acquiredpneumonia(CAP).TheobjectivesofthisstudyweretoevaluateinhospitalizedpatientswithCAP,ifabnormalplateletcountwasassociatedwith30-daymortality,andtocompareplateletcountandleukocytecountaspredictorsof30-daymortality.METHODS:Weperformedaretrospectivecohortstudyof500consecutivepatientshospitalizedwithCAPattheVeteransHospitalofLouisville,KYbetweenJune2001andMarch2006toinvestigatetheassociationofplateletcountandleukocytecountwith30-daymortality.Predictorvariableswereplateletcountandleukocytecount.Abnormalplateletcountwaslessthan100,000/L(thrombocytopenia)andgreaterthan400,000/L(thrombocytosis).Theoutcomevariablewas30-daymortality.Tocontrolforpotentialconfounding,apropensityscorethatincorporated33variableswasused.RESULTS:Plateletcountwasstronglyassociated(P=0.0009)with30-daymortalitywhilenoassociationwasobservedforleukocytecount(P=0.5114).Highplateletcountsresultedinasignificantlyincreasedriskofmortality.CONCLUSIONS:ThrombocytopeniaandthrombocytosisareassociatedwithmortalityinpatientshospitalizedwithCAP.WhenevaluatinganinitialCBCtestinpatientswithCAP,anabnormalplateletcountisabetterpredictorofoutcomethananabnormalleukocytecount.精選課件【據(jù)《Chest》2010年2月報(bào)道】題：住院期間血小板增多或減少可預(yù)測(cè)社區(qū)獲得性肺炎患者死亡率（作者：MirsaeidiM等）血小板屬于炎癥細(xì)胞，在抗微生物宿主防御中起重要作用。據(jù)推測(cè)血小板計(jì)數(shù)異常也許是社區(qū)獲得性肺炎（CAP）患者病情嚴(yán)重的一個(gè)標(biāo)志。美國(guó)路易斯維爾大學(xué)MirsaeidiM等開(kāi)展了一項(xiàng)回顧性隊(duì)列研究，評(píng)估了CAP住院患者異常的血小板計(jì)數(shù)是否與其30天死亡率相關(guān)，并對(duì)血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)作為30天死亡率的預(yù)測(cè)因子進(jìn)行比較。此研究納入500例連續(xù)的CAP患者，調(diào)查血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)與患者30天死亡率的關(guān)系。預(yù)測(cè)變量為血小板計(jì)數(shù)和白細(xì)胞計(jì)數(shù)。異常血小板計(jì)數(shù)為＜100000/L（血小板減少）和＞400000/L（血小板增多）。結(jié)局變量為30天死亡率。應(yīng)用包括33個(gè)變量的傾向評(píng)分控制潛在混雜因素。結(jié)果顯示，血小板計(jì)數(shù)與30天死亡率強(qiáng)烈相關(guān)（P=0.0009），未發(fā)現(xiàn)白細(xì)胞計(jì)數(shù)與30天死亡率的關(guān)系。高血小板計(jì)數(shù)可致患者死亡率顯著增加。研究表明，血小板增多或減少與住院的CAP患者的死亡率相關(guān)。當(dāng)對(duì)CAP患者進(jìn)行初始CBC檢測(cè)評(píng)估時(shí)，異常的血小板計(jì)數(shù)比異常的白細(xì)胞計(jì)數(shù)更能預(yù)測(cè)患者結(jié)局精選課件5.重度社區(qū)獲得性肺炎患者入住ICU較晚與

死亡率較高相關(guān)

【據(jù)《Chest》2010年3月報(bào)道】題：晚期入住ICU與社區(qū)獲得性肺炎患者的高死亡率相關(guān)（作者：RestrepoMI等）有關(guān)入住ICU的時(shí)間對(duì)重度社區(qū)獲得性肺炎（CAP）結(jié)局的影響的可靠數(shù)據(jù)有限，美國(guó)南德克薩斯退伍軍人醫(yī)療保健系統(tǒng)RestrepoMI等此次研究旨在調(diào)查入住ICU的時(shí)間與重度CAP患者30天死亡率的關(guān)系。此項(xiàng)在兩個(gè)三級(jí)教學(xué)醫(yī)院開(kāi)展的，為期超過(guò)3年的回顧性隊(duì)列研究，納入161例入住ICU的CAP患者（國(guó)際疾病分類，第9次修訂、編碼）。將入住ICU的時(shí)間劃分為兩個(gè)級(jí)別，即早入住ICU（EICUA，直接入住或在24小時(shí)內(nèi)入?。?，入住ICU較晚（LICUA，≥2天入?。?yīng)用Cox比例危害模型進(jìn)行多變量分析，主要測(cè)量結(jié)果為30天死亡率、美國(guó)胸科協(xié)會(huì)（ATS）疾病嚴(yán)重程度判定和入住ICU的時(shí)間。結(jié)果顯示，88%（n=142）為EICUA患者，12%（n=19）為L(zhǎng)ICUA患者。兩組患者在年齡、性別、共病、臨床參數(shù)、CAP相關(guān)的護(hù)理方法以及需要機(jī)械通氣方面相似。入院時(shí)LICUA患者ATS嚴(yán)重程度標(biāo)準(zhǔn)的符合率較低（26.3%vs.53.5%；P=0.03）。與EICUA患者相比，LICUA患者的死亡率較高（47.4%vs.23.2%，P=0.02），經(jīng)多變量分析校正后這種關(guān)系依然存在（HR，2.6；P=0.02）。研究表明，在校正疾病嚴(yán)重程度后，重度CAP患者入住ICU時(shí)間較晚可增加患者30天死亡率。進(jìn)一步的研究應(yīng)該探討影響較晚入住ICU的危險(xiǎn)因素及其對(duì)這些患者臨床結(jié)局的影響。共同進(jìn)食蔬菜和水果可使孕婦上呼吸道感染風(fēng)險(xiǎn)降低【據(jù)《PublicHealthNutr.》2010年2月報(bào)道】題：進(jìn)食蔬菜和水果與孕婦上呼吸道感染風(fēng)險(xiǎn)間的關(guān)系（作者：LiLWerlerMM）美國(guó)波士頓大學(xué)公共衛(wèi)生學(xué)院流行病學(xué)系LiL與WerlerMM開(kāi)展此次研究，旨在評(píng)估在妊娠期間進(jìn)食蔬菜和水果與上呼吸道感染（URTI)）發(fā)生率之間的關(guān)系。研究納入北美婦女1034例，讓其回顧其在妊娠前6個(gè)月進(jìn)食蔬菜和水果與在妊娠前半期時(shí)URTI的發(fā)生率。用Cox比例危害模型計(jì)算多變量校正危害比（HR）。結(jié)果顯示，攝入總的水果和蔬菜量的最高四分位（中位量8.54servings/d）vs.最低四分位（中位量1.91servings/d）的婦女，在隨訪5個(gè)月時(shí)發(fā)生URTI的校正HR為0.74，隨訪3個(gè)月時(shí)為0.61。在隨訪3個(gè)月時(shí)攝入的水果和蔬菜與URTI風(fēng)險(xiǎn)降低呈劑量相關(guān)，但隨訪5個(gè)月時(shí)無(wú)此相關(guān)性。未發(fā)現(xiàn)單獨(dú)進(jìn)食蔬菜或水果與5個(gè)月或3個(gè)月時(shí)URTI風(fēng)險(xiǎn)的關(guān)系。研究表明，婦女進(jìn)食蔬菜和水果較多可中度降低妊娠期間URTI的風(fēng)險(xiǎn)，這種獲益似乎來(lái)源于蔬菜與水果共同進(jìn)食而非單一進(jìn)食。ExaminationQuestions不定項(xiàng)選擇題1.進(jìn)食蔬菜和水果與孕婦上呼吸道感染風(fēng)險(xiǎn)的關(guān)系，下列說(shuō)法正確的是（）A進(jìn)食蔬菜和水果與孕婦上呼吸道感染風(fēng)險(xiǎn)無(wú)關(guān)B單進(jìn)食蔬菜可以降低孕婦上呼吸道感染風(fēng)險(xiǎn)C單進(jìn)食水果可以降低孕婦上呼吸道感染風(fēng)險(xiǎn)D共同進(jìn)食蔬菜和水果可以降低孕婦上呼吸道感染風(fēng)險(xiǎn)精選課件BACKGROUND:LimiteddataareavailableontheimpactoftimetoICUadmissionandoutcomesforpatientswithseverecommunityacquiredpneumonia(CAP).OurobjectivewastoexaminetheassociationoftimetoICUadmissionand30-daymortalityinsevereCAPpatients.METHODS:Aretrospectivecohortstudyof161ICUCAPsubjects(byICD-9codes)wasconductedoverathreeyearperiodattwotertiaryteachinghospitals.TimingoftheICUadmissionwasdichotomizedintoearlyICUadmission(EICUA-directadmissionorwithin24hours)andlateICUadmission(LICUA->/=day2).AmultivariableanalysisusingCoxproportionalhazardmodelwascreatedwiththeprimaryoutcomeof30-daymortality(dependentmeasure),andtheAmericanThoracicSociety(ATS)severityadjustmentcriteriaandtimetoICUadmissionastheindependentmeasures.RESULTS:Eighty-eightpercent(n=142)wereEICUAcomparedto12%(n=19)LICUApatients.Groupsweresimilarwithrespecttoage,gender,comorbidities,clinicalparameters,andCAP-relatedprocessofcaremeasures,andneedformechanicalventilation.LICUApatientshadlowerratesofATSseveritycriteriaatpresentation(26.3%vs.53.5%;p=0.03).LICUApatients(47.4%)hadahigher30-daymortalitycomparedtoEICUA(23.2%)patients(p=0.02),andremainedafteradjustinginthemultivariableanalysis(Hazardratio2.6,95%ConfidenceInterval1.2-5.5;p=0.02).CONCLUSION:SevereCAPpatientswithalateICUadmissionhaveincreased30-daymortalityafteradjustmentforseverityofillness.FurtherresearchshouldevaluatetheriskfactorsassociatedandtheirimpactonclinicaloutcomesinpatientsadmittedlatetotheICU.精選課件AntibioticUseintheManagementofPulmonaryNodules.

BACKGROUND:Pulmonarynodulesarecommonincidentalfindingsonthoracicimaging.Thisstudysoughttodeterminewhetherantibioticuseisassociatedwithanyimprovementinnoduleappearanceandtoidentifyclinicalfindingsandnodulecharacteristicspotentiallyinfluencingthedecisiontoprescribeantibiotics.METHODS:ElectronicmedicalrecordswerereviewedofoutpatientsreferredtoametropolitancancercenterforpulmonarynodulesseenonchestCTscansthatdidnotundergobiopsy.Theprimaryendpointwastheappearanceofeachnoduleonthefirstfollow-upscan.Asubsetanalysiswasperformedforpatientsmanifestingsymptomsorradiographicfindingssuggestinginfection.Ananalysiswasperformedtodeterminewhatclinicalandradiographicfindingswereassociatedwiththedecisiontoprescribeantibiotics.RESULTS:BetweenJanuary2003andDecember2004,143evaluationswereperformedfor293nodules.Antibioticswereprescribedamong34(24%)evaluations.Atrendtowardsimprovementwasseenwithantibioticuse,whichwasnotsignificant.Thepercentageofnodulesthatimprovedwas33%amongthosereceivingantibioticsand27%amongthosewhodidnot(Oddsratio1.33,95%CI0.55-3.27).Among63patientswithpulmonarysymptoms,41%ofnodulesimprovedamongthosereceivingantibioticsand28%amongthosewhodidnot(Oddsratio1.78,95%CI0.42-7.78).Thedecisiontoprescribeantibioticswasassociatedonlywithlargernodulesizeandbronchiectasis.CONCLUSION:Thesedatadonotsupportantibioticuseforpulmonarynodules.However,thetrendtowardsimprovednoduleappearancesuggeststhatlargerprospectivetrialsarewarrantedtoclarifytheroleofantibioticsinmanaginglungnodules.精選課件ClinicalOutbreakofLinezolid-ResistantstaphylococcusaureusinanIntensivenCareUnitCONTEXT:LinezolidresistanceisextremelyuncommoninStaphylococcusaureus.OBJECTIVE:Toreportanoutbreakwithlinezolidandmethicillin-resistantSaureus(LRSA)inanintensivecaredepartmentandtheeffectivecontrolmeasurestaken.Design,Setting,andPATIENTS:Outbreakstudyofconsecutivecriticallyillpatientscolonizedand/orinfectedwithLRSAatanintensivecaredepartmentofa10