Dudas V, Hopefl A, Jacobs R, Guglielmo B J
University of California, San Francisco 94143, USA.
Ann Pharmacother. 2000 Apr;34(4):446-52. doi: 10.1345/aph.19174.
To describe and evaluate empiric antimicrobial regimens chosen for hospitalized patients with presumed community-acquired pneumonia (CAP) in US hospitals, including compliance with the American Thoracic Society (ATS) guidelines. Secondary outcomes included length of stay (LOS) and mortality associated with the choice of therapy.
A nonrandomized, prospective, observational study was performed in 72 nonteaching hospitals affiliated with a national group purchasing organization. Patients with an admission diagnosis of physician-presumed CAP and an X-ray taken within 72 hours of admission were eligible for the study. Demographic, antibiotic selection, and outcomes data were collected prospectively from patient charts.
3035 patients were enrolled; 2963 were eligible for analysis. Compliance with the ATS guidelines was 81% in patients with nonsevere CAP. The most common antibiotic regimen used for empiric treatment was ceftriaxone alone or in combination with a macrolide (42%). The overall mortality rate was 5.5%. The addition of a macrolide to either a second- or third-generation cephalosporin or a beta-lactam/beta-lactamase inhibitor was associated with decreased mortality and reduced LOS.
Most hospitalized patients with CAP receive antimicrobial therapy consistent with the ATS guidelines. The addition of a macrolide may be associated with improved patient outcomes.
描述并评估美国医院中为疑似社区获得性肺炎（CAP）的住院患者选择的经验性抗菌治疗方案，包括对美国胸科学会（ATS）指南的遵循情况。次要结局包括住院时间（LOS）以及与治疗选择相关的死亡率。
在隶属于一个全国性集团采购组织的72家非教学医院中进行了一项非随机、前瞻性观察性研究。入院诊断为医生疑似CAP且在入院72小时内进行了X线检查的患者符合研究条件。从患者病历中前瞻性收集人口统计学、抗生素选择及结局数据。
共纳入3035例患者；2963例符合分析条件。非重症CAP患者对ATS指南的遵循率为81%。经验性治疗最常用的抗生素方案是单用头孢曲松或与大环内酯类联合使用（42%）。总死亡率为5.5%。在第二代或第三代头孢菌素或β-内酰胺/β-内酰胺酶抑制剂中添加大环内酯类与死亡率降低和住院时间缩短相关。
大多数住院CAP患者接受了符合ATS指南的抗菌治疗。添加大环内酯类可能与改善患者结局相关。
