Serisier David J, Bowler Simon D
Department of Respiratory Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia.
Respirology. 2007 May;12(3):389-93. doi: 10.1111/j.1440-1843.2007.01058.x.
Both the speed of commencement and the appropriateness of i.v. antibiotic administration influence outcomes in patients hospitalized with community-acquired pneumonia (CAP). While quality improvement projects have been linked to better CAP management and outcomes, there are limited data evaluating simple and achievable interventions.
A simple educational programme targeting rapid and appropriate antibiotic administration for the inpatient treatment of CAP was evaluated using a retrospective chart review of all patients admitted through the emergency department with CAP during 'pre-intervention' and 'post-intervention' periods.
There were 108 pre-intervention patients (56 women, median age 63 years) and 88 post-intervention patients (43 women, median age 61 years) included in the evaluation. Comparison of indicators of care in the post-intervention period with those in the pre-intervention period showed there were significant changes in: median time to antibiotic administration (2.5 h vs 3.5 h, 95% CI: 0-1.25, P = 0.01); subjects not prescribed macrolide antibiotics (2.3% vs 10.2%, 95% CI for OR 1.02-46.19, P = 0.04); hospital length of stay (3.5 vs 6 days, 95% CI: 1-3, P < 0.001) and mortality (0% vs 6.5%, 95% CI for OR 1.13 to infinity, P = 0.02).
A simple, inexpensive educational intervention was associated with significant improvements in the hospital management of CAP. The widespread introduction of similar programmes has the potential to effect substantial improvements in management, and possibly patient outcomes, and requires prospective confirmation in a larger, randomized sample.
静脉注射抗生素的开始速度和使用合理性均会影响社区获得性肺炎（CAP）住院患者的治疗结果。虽然质量改进项目与更好的CAP管理及治疗结果相关，但评估简单可行干预措施的数据有限。
通过回顾性图表审查，对在“干预前”和“干预后”期间经急诊科收治的所有CAP患者进行评估，以评价一项针对CAP住院治疗中快速且合理使用抗生素的简单教育计划。
评估纳入了108例干预前患者（56例女性，中位年龄63岁）和88例干预后患者（43例女性，中位年龄61岁）。干预后时期与干预前时期护理指标的比较显示，以下方面有显著变化：抗生素给药的中位时间（2.5小时对3.5小时，95%CI：0 - 1.25，P = 0.01）；未开具大环内酯类抗生素的患者（2.3%对10.2%，OR的95%CI为1.02 - 46.19，P = 0.04）；住院时间（3.5天对6天，95%CI：1 - 3，P < 0.001）和死亡率（0%对6.5%，OR的95%CI为1.13至无穷大，P = 0.02）。
一项简单、低成本的教育干预与CAP的医院管理显著改善相关。广泛推行类似计划有可能大幅改善管理，并可能改善患者治疗结果，这需要在更大规模的随机样本中进行前瞻性证实。
