Malone D C, Shaban H M
College of Pharmacy, University of Arizona, Tucson 85721-0207, USA.
Ann Pharmacother. 2001 Oct;35(10):1180-5. doi: 10.1345/aph.10283.
To compare outcomes of care and antibiotic utilization for community-acquired pneumonia (CAP) throughout a group of not-for-profit hospitals.
A retrospective chart review of patients from community hospitals with a diagnosis of pneumonia at discharge admitted from December 1997 to May 1998. Data were collected based on American Thoracic Society (ATS) criteria.
Medical records of 330 patients were reviewed; mortality was 7%. Using ATS guidelines, 51 (15.5%) patients were not treated with recommended antimicrobial therapy. Of these patients, 14 had nonsevere cases of CAP and 37 cases were severe. Factors found to be associated with in-hospital mortality included nonadherence to ATS guidelines (OR 4.46; 95% CI 1.38 to 14.43), decreased urine output (OR 7.72; 95% CI 1.70 to 35.04), and increasing age (OR 1.06; 95% CI 1.01 to 1.12). Significant predictors of length of stay (LOS) included age, nonadherence to ATS criteria, suspected aspiration, discharge status, low pulse oximetry on admission, decreased urine output, use of vasopressor medications, and interstitial lung disease; More than 80% of patients had at least one culture performed, but only 27.5% of these cultures were positive. The most cpmmonly prescribed antibiotic was cefuroxime injection, representing 25% of the antibiotic orders.
Patients with CAP treated inconsistently with ATS guidelines had a 4.46-d higher risk of inpatient mortality and had significantly longer LOS.
比较一组非营利性医院中社区获得性肺炎（CAP）的护理结局和抗生素使用情况。
对1997年12月至1998年5月期间社区医院出院诊断为肺炎的患者进行回顾性病历审查。数据收集基于美国胸科学会（ATS）标准。
审查了330例患者的病历；死亡率为7%。根据ATS指南，51例（15.5%）患者未接受推荐的抗菌治疗。其中，14例为非重症CAP患者，37例为重症患者。发现与住院死亡率相关的因素包括未遵循ATS指南（比值比4.46；95%置信区间1.38至14.43）、尿量减少（比值比7.72；95%置信区间1.70至35.04）和年龄增加（比值比1.06；95%置信区间1.01至1.12）。住院时间（LOS）的显著预测因素包括年龄、未遵循ATS标准、疑似误吸、出院状态、入院时脉搏血氧饱和度低、尿量减少、使用血管加压药物和间质性肺疾病；超过80%的患者至少进行了一次培养，但这些培养中只有27.5%呈阳性。最常开具的抗生素是头孢呋辛注射液，占抗生素医嘱的25%。
CAP患者若未按照ATS指南进行治疗，住院死亡率风险高出4.46倍，住院时间显著更长。
