医学病房中社区获得性肺炎患者非典型覆盖范围的影响：美国社区获得性肺炎项目的结果

Impact of atypical coverage for patients with community-acquired pneumonia managed on the medical ward: results from the United States Community-Acquired Pneumonia Project.

作者信息

Frei Christopher R, Koeller Jim M, Burgess David S, Talbert Robert L, Johnsrud Michael T

机构信息

College of Pharmacy, University of Texas, Austin, USA.

出版信息

Pharmacotherapy. 2003 Sep;23(9):1167-74. doi: 10.1592/phco.23.10.1167.32764.

DOI:10.1592/phco.23.10.1167.32764

PMID:14524648

Abstract

STUDY OBJECTIVE

As current guidelines for treatment of community-acquired pneumonia (CAP) recommend empiric antimicrobial coverage for atypical pathogens, we evaluated the need for atypical coverage by examining length of hospital stay (LOS) and mortality in patients with CAP who were managed on the medical ward.

METHODS

Medical records of patients with CAP admitted from January 1, 1997-December 31, 2001, from 176 United States nonteaching community hospitals were reviewed. Patients were divided into one of three mutually exclusive groups on the basis of intravenous antimicrobials received on days 1 or 2 of hospital stay: ceftriaxone monotherapy, ceftriaxone plus a macrolide, or levofloxacin. Variables evaluated for their ability to predict outcome were patient age, year of hospital admission, geographic region, preadmission setting, preadmission antimicrobial treatment, timing of antimicrobial administration, comorbid disease, and duration of intravenous antimicrobial treatment. The impact of initial antimicrobial regimen on LOS and mortality was evaluated in regression models while controlling for significant predictors of outcome.

RESULTS

Of 8975 patients evaluated, 2453 met the inclusion criteria. Significant differences were noted among patients who received ceftriaxone (932 patients), ceftriaxone plus a macrolide (872), and levofloxacin (649) with respect to mean +/- SD age (72 +/- 16, 67 +/- 18, and 70 +/- 17 yrs, respectively; p<0.0001), admission from a nursing home (21%, 11%, and 15%, respectively; p<0.0001), and duration of intravenous antimicrobial treatment (4.4 +/- 2.7, 4.0 +/- 2.6, and 3.6 +/- 2.5 days, respectively; p<0.0001). The LOS predictors were age, geographic region, coexisting heart failure, and duration of intravenous antimicrobial therapy. Mortality predictors were age, admission from a nursing home, coexisting heart failure, and coexisting cancer. After controlling for these predictors of outcome, no significant differences were noted among the three groups for LOS (5.5 +/- 3.5, 4.8 +/- 2.9, and 4.8 +/- 2.9 days, respectively; p=0.2791) or mortality (3.1%, 2.0%, and 2.6%, respectively; p=0.8461).

CONCLUSION

Initial coverage for atypical pathogens does not affect LOS or mortality among patients with CAP managed on the medical ward.

摘要

研究目的

由于目前社区获得性肺炎（CAP）的治疗指南推荐对非典型病原体进行经验性抗菌覆盖，我们通过检查在内科病房接受治疗的CAP患者的住院时间（LOS）和死亡率，评估了非典型覆盖的必要性。

方法

回顾了1997年1月1日至2001年12月31日期间从176家美国非教学社区医院收治的CAP患者的病历。根据住院第1天或第2天接受的静脉抗菌药物，将患者分为三个相互排斥的组之一：头孢曲松单药治疗、头孢曲松加一种大环内酯类药物或左氧氟沙星。评估其预测结局能力的变量包括患者年龄、入院年份、地理区域、入院前环境、入院前抗菌治疗、抗菌药物给药时间、合并疾病以及静脉抗菌治疗持续时间。在控制结局的显著预测因素的同时，在回归模型中评估初始抗菌方案对LOS和死亡率的影响。

结果

在评估的8975例患者中，2453例符合纳入标准。接受头孢曲松治疗的患者（932例）、头孢曲松加一种大环内酯类药物治疗的患者（872例）和左氧氟沙星治疗的患者（649例）在平均±标准差年龄（分别为72±16、67±18和70±17岁；p<0.0001）、从养老院入院（分别为21%、11%和15%；p<0.0001）以及静脉抗菌治疗持续时间（分别为4.4±2.7、4.0±2.6和3.6±2.5天；p<0.0001）方面存在显著差异。LOS的预测因素为年龄、地理区域、并存的心力衰竭以及静脉抗菌治疗持续时间。死亡率的预测因素为年龄、从养老院入院、并存的心力衰竭以及并存的癌症。在控制这些结局预测因素后，三组之间在LOS（分别为5.5±3.5、4.8±2.9和4.8±2.9天；p=0.2791）或死亡率（分别为3.1%、2.0%和2.6%；p=0.8461）方面未发现显著差异。