Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Lung. 2010 Apr;188(2):173-8. doi: 10.1007/s00408-009-9216-9.
Limited information is available about current practice patterns involving the use of antibiotics in the inpatient management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). We sought to characterize current patterns of antibiotic use and to compare them to evidence-based guidelines. This study is a retrospective case series of patients at a regional tertiary care medical center. Charts were reviewed to identify patients admitted between January 2006 and 2008 with an initial diagnosis of AECOPD who had no evidence of another infectious process and who were not immunocompromised. Relevant data extracted from charts included initial clinical presentation, antibiotic administration, microbiological studies, and hospital course. One hundred sixteen admissions meeting inclusion criteria were identified. There was no statistically significant relationship between the presence of an established indication for antibiotic administration and the use of antibiotics, with roughly 75% of patients in all groups receiving therapy. A significant fraction of patients received combination therapy that was more appropriate for the management of pneumonia than for AECOPD. There were significant deviations between practice patterns and guidelines regarding the use and selection of antibiotics. Some of these may reflect areas of uncertainty in the primary literature and varying sets of guidelines.
关于在慢性阻塞性肺疾病急性加重（AECOPD）的住院管理中使用抗生素的当前实践模式，目前的信息有限。我们试图描述当前抗生素使用模式，并将其与循证指南进行比较。本研究是对一家地区性三级保健医疗中心的患者进行的回顾性病例系列研究。对病历进行了回顾，以确定在 2006 年 1 月至 2008 年期间，初始诊断为 AECOPD 且无其他感染过程证据且无免疫功能低下的患者入院情况。从病历中提取的相关数据包括初始临床表现、抗生素使用、微生物学研究和住院过程。符合纳入标准的 116 例入院患者。对于抗生素治疗的适应证，抗生素的使用与存在之间没有统计学上的显著关系，所有组别的患者中约有 75%接受了治疗。相当一部分患者接受了联合治疗，这种治疗方法更适合于肺炎的治疗，而不是 AECOPD。在抗生素的使用和选择方面，实践模式和指南之间存在显著差异。其中一些可能反映了初级文献中的不确定领域和不同的指南集。
