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已发表论文
每日一次与每日多次痰培养指导ICU肺部感染患者抗生素治疗的比较：一项回顾性队列研究
Authors Wang JY, Liu Z, Xia QC, Chu WW , Liang DY, Huang YM, Jia XL, Yu WL , Xia FP, Sun Y, Lu ZH
Received 30 September 2025
Accepted for publication 19 January 2026
Published 22 January 2026 Volume 2026:19 567559
DOI https://doi.org/10.2147/IDR.S567559
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Oliver Planz
Ji-Yun Wang,1,2,* Zhi Liu,1,* Qian-Cheng Xia,1 Wen-Wen Chu,3 Dai-Yun Liang,1 You-Ming Huang,2 Xue-Li Jia,1 Wei-Li Yu,1 Fei-Ping Xia,4 Yun Sun,1 Zhong-Hua Lu1,*
1The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People’s Republic of China; 3Department of Clinical Laboratory, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 4Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhong-Hua Lu, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email luzhonghua077@126.com Yun Sun, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email sunyun9653@126.com
Background: Effective antibiotic management is crucial for ICU patients with pulmonary infections. However, guidelines are unclear whether the optimal strategy is multiple cultures on the infection onset day or a single daily culture to guide antibiotic therapy.
Methods: This study involved 362 ICU patients with confirmed pulmonary infections, categorized into a “multiple-daily” group (≥ 2 cultures within 24 hours) and a “once-daily” group (1 culture per 24 hours). Propensity score matching was used to balance baseline characteristics. Primary outcome was antibiotic adjustment rate. Secondary outcomes included mechanical ventilation duration, ICU and total hospital length of stay, hospitalization costs, and mortality.
Results: The multiple-daily group had more frequent antibiotic adjustments both before and after matching (76.88% vs 67.33%, p = 0.048 pre-matching; p = 0.076 post-matching). The once-daily group experienced significantly shorter durations of mechanical ventilation (pre: 119.50 vs 159.50 hours; post: 116.00 vs 156.00 hours; both p < 0.001), ICU stay (pre: 10.00 vs 13.00 days; post: 9.00 vs 13.00 days; both p < 0.001), and lower hospitalization costs (pre: 138,150 vs 167,910 CNY, p = 0.011; post: 136,870 vs 167,780 CNY, p = 0.004). The hospital stay was also shorter in the once-daily group, with similar mortality rates between groups. Common multidrug-resistant pathogens included CRAB (32.52%), MRSA (24.39%), ESBL (18.70%), CRPA (15.45%), and CRE (12.00%). The multiple-daily group had higher detection rates of CRAB (38.46% vs 25.86%, p= 0.050) and MRSA (30.77% vs 17.24%, p= 0.048), with more frequent antibiotic adjustments, especially in multidrug-resistant cases (87.69% vs 70.69%, p= 0.019).
Conclusion: In ICU patients with pulmonary infections, multiple-daily sputum cultures lead to more frequent antibiotic adjustments and better detection of multidrug-resistant pathogens. However, a once-daily culture strategy is associated with reduced healthcare resource utilization and comparable mortality. Further randomized trials are needed to determine the optimal sputum culture frequency in the ICU setting.
Trial Registration: This study was registered with the Chinese Clinical Trial Registry under the registration number ChiCTR2400091085.
Keywords: antibiotic management, pulmonary infections, sputum culture frequency, multidrug-resistant, propensity score matching
1The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, People’s Republic of China; 3Department of Clinical Laboratory, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 4Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhong-Hua Lu, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email luzhonghua077@126.com Yun Sun, The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China, Email sunyun9653@126.com
Background: Effective antibiotic management is crucial for ICU patients with pulmonary infections. However, guidelines are unclear whether the optimal strategy is multiple cultures on the infection onset day or a single daily culture to guide antibiotic therapy.
Methods: This study involved 362 ICU patients with confirmed pulmonary infections, categorized into a “multiple-daily” group (≥ 2 cultures within 24 hours) and a “once-daily” group (1 culture per 24 hours). Propensity score matching was used to balance baseline characteristics. Primary outcome was antibiotic adjustment rate. Secondary outcomes included mechanical ventilation duration, ICU and total hospital length of stay, hospitalization costs, and mortality.
Results: The multiple-daily group had more frequent antibiotic adjustments both before and after matching (76.88% vs 67.33%, p = 0.048 pre-matching; p = 0.076 post-matching). The once-daily group experienced significantly shorter durations of mechanical ventilation (pre: 119.50 vs 159.50 hours; post: 116.00 vs 156.00 hours; both p < 0.001), ICU stay (pre: 10.00 vs 13.00 days; post: 9.00 vs 13.00 days; both p < 0.001), and lower hospitalization costs (pre: 138,150 vs 167,910 CNY, p = 0.011; post: 136,870 vs 167,780 CNY, p = 0.004). The hospital stay was also shorter in the once-daily group, with similar mortality rates between groups. Common multidrug-resistant pathogens included CRAB (32.52%), MRSA (24.39%), ESBL (18.70%), CRPA (15.45%), and CRE (12.00%). The multiple-daily group had higher detection rates of CRAB (38.46% vs 25.86%, p= 0.050) and MRSA (30.77% vs 17.24%, p= 0.048), with more frequent antibiotic adjustments, especially in multidrug-resistant cases (87.69% vs 70.69%, p= 0.019).
Conclusion: In ICU patients with pulmonary infections, multiple-daily sputum cultures lead to more frequent antibiotic adjustments and better detection of multidrug-resistant pathogens. However, a once-daily culture strategy is associated with reduced healthcare resource utilization and comparable mortality. Further randomized trials are needed to determine the optimal sputum culture frequency in the ICU setting.
Trial Registration: This study was registered with the Chinese Clinical Trial Registry under the registration number ChiCTR2400091085.
Keywords: antibiotic management, pulmonary infections, sputum culture frequency, multidrug-resistant, propensity score matching