Wenisch C, Krause R, Széll M, Laferl H
Medizinische Abteilung mit Infektions- und Tropenmedizin, SMZ-Süd-KFJ Spital, Kundratstrasse 3, 1100, Wien, Austria.
Infection. 2006 Aug;34(4):190-5. doi: 10.1007/s15010-006-5120-x.
The failure rate of primary empirical anti-infective treatment of community-acquired pneumonia is reported to range between 2 and 7%. These patients are subject to a greater risk of intensive medical treatment and a higher mortality rate than patients who respond to primary treatment. We investigated 63 patients in a "real life scenario" who were admitted to the hospital after failure of primary outpatient therapy for community-acquired pneumonia. Thirty-three patients received intravenous standard therapy (betalactam 14, macrolide 3, levofloxacin 6, doxycycline 1, combinations 9 patients) while 30 patients were treated with intravenous moxifloxacin. The oral antibiotic pretreatment that failed most frequently was clarithromycin (n = 25), followed by amoxicillin/clavulanic acid (n = 16), cefixime (n = 10), cefuroxime/axetil (n = 5), doxycycline (3), cefpodoxime, and ciprofloxacin (2 each). There were no differences between the two groups in respect of age, gender, numbers of patients in nursing homes, numbers of patients with different underlying diseases (chronic bronchitis, coronary heart disease, diabetes mellitus, smoking, etc.), severity of pneumonia at the time of admission, numbers of patients requiring intensive care, and lethality. The group that underwent standard therapy experienced failure of the empirical intra-hospital antibiotic therapy more often during therapy [10 (30%) patients vs 2 (6%) in the moxifloxacin group, p = 0.009] and clinical failure of treatment on day 28 after initiation of therapy [7 (21%) patients vs 2 (6%) in the moxifloxacin group, p = 0.003]. In cases of failure of empirical preclinical antibiotic treatment for community-acquired pneumonia, subsequent intrahospital treatment with moxifloxacin is more successful than standard therapy in our study reflecting a "real life scenario".
据报道，社区获得性肺炎初始经验性抗感染治疗的失败率在2%至7%之间。与初始治疗有反应的患者相比，这些患者接受强化治疗的风险更高，死亡率也更高。我们在“现实生活场景”中调查了63例社区获得性肺炎初始门诊治疗失败后入院的患者。33例患者接受静脉标准治疗（β-内酰胺类14例、大环内酯类3例、左氧氟沙星6例、多西环素1例、联合用药9例），而30例患者接受静脉莫西沙星治疗。最常失败的口服抗生素预处理药物是克拉霉素（n = 25），其次是阿莫西林/克拉维酸（n = 16）、头孢克肟（n = 10）、头孢呋辛酯（n = 5）、多西环素（3例）、头孢泊肟和环丙沙星（各2例）。两组在年龄、性别、养老院患者数量、不同基础疾病（慢性支气管炎、冠心病、糖尿病、吸烟等）患者数量、入院时肺炎严重程度、需要重症监护的患者数量和死亡率方面无差异。接受标准治疗的组在治疗期间经验性院内抗生素治疗失败的情况更常见[10例（30%）患者，而莫西沙星组为2例（6%），p = 0.009]，且在治疗开始后第28天治疗的临床失败情况也更常见[7例（21%）患者，而莫西沙星组为2例（6%），p = 0.003]。在我们反映“现实生活场景”的研究中，对于社区获得性肺炎初始临床前抗生素治疗失败的病例，随后院内使用莫西沙星治疗比标准治疗更成功。
