Lin Robert Y, Nuruzzaman Farzana, Shah Shaili N
Department of Medicine, St. Vincent's Hospital-Manhattan-Saint Vincent Catholic Medical Centers, New York, New York 10011, USA.
J Hosp Med. 2009 Feb;4(2):E7-15. doi: 10.1002/jhm.414.
This study sought to define the incidence, economic impact, and nature of adverse drug effects (ADEs) related to antibiotics in pneumonia hospitalizations in the US.
Adult pneumonia hospitalizations were tabulated in statewide (New York) and national databases, respectively, from 2000 through 2005. The incidences of antibiotic related ADEs were determined by identifying antibiotic specific e-codes (external cause of injury codes). The modeled effect of the presence of antibiotic ADEs on length of stay (LOS) and total charges were also calculated. ADEs due to specific antibiotic classes, and the presence of certain cutaneous allergic and gastro-intestinal manifestations commonly attributable to ADEs, were tabulated.
ADEs related to antibiotics were reported in a small but consistent proportion (0.45-0.6%) of pneumonia hospitalizations in both cohorts. The most common identifiable antibiotics class associated with ADEs was the cephalosporins followed by penicillins and quinolones. Over 60% of the ADEs were associated with reported dermal/allergic and gastro-intestinal manifestations. Multivariate analysis adjusting for co-morbid conditions and demographic factors showed that the presence of an antibiotic adverse drug effect was a significant independent predictor of greater LOS and higher total hospital charges.
ADEs related to antibiotics can be identified by analyzing administrative hospitalization databases. For pneumonia, a common hospitalization diagnosis, there is a defined calculable impact and incidence of antibiotic associated adverse effects. This should be considered in planning hospitalization resource allocation and in developing equitable hospitalization reimbursements. Identifying the nature of antibiotic associated adverse effects may facilitate the development of strategies for reducing these adverse effects.
本研究旨在确定美国肺炎住院患者中与抗生素相关的药物不良反应（ADEs）的发生率、经济影响及性质。
分别在纽约州和全国数据库中统计2000年至2005年期间成人肺炎住院病例。通过识别抗生素特定的电子编码（损伤外部原因编码）来确定抗生素相关ADEs的发生率。还计算了存在抗生素ADEs对住院时间（LOS）和总费用的模拟影响。列出了特定抗生素类别导致的ADEs，以及通常归因于ADEs的某些皮肤过敏和胃肠道表现。
两个队列中，肺炎住院患者中均有一小部分但比例一致（0.45 - 0.6%）报告了与抗生素相关的ADEs。与ADEs相关的最常见可识别抗生素类别是头孢菌素，其次是青霉素和喹诺酮类。超过60%的ADEs与报告的皮肤/过敏和胃肠道表现相关。对合并症和人口统计学因素进行调整的多变量分析表明，存在抗生素药物不良反应是住院时间延长和医院总费用增加的显著独立预测因素。
通过分析行政住院数据库可识别与抗生素相关的ADEs。对于肺炎这种常见的住院诊断，抗生素相关不良反应存在明确的可计算影响和发生率。在规划住院资源分配和制定公平的住院报销政策时应予以考虑。确定抗生素相关不良反应的性质可能有助于制定减少这些不良反应的策略。
