EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
J Am Med Dir Assoc. 2012 Feb;13(2):156-61. doi: 10.1016/j.jamda.2010.07.001. Epub 2010 Oct 8.
To describe long-term mortality rate and to assess associations between mortality rate and antibiotic treatment of lower respiratory infection in patients with advanced dementia; antibiotic treatment allocation was independent of mortality risk-leaving less room for biased associations than in previous multicenter observational studies.
Prospective study (2004-2009). Multilevel Cox proportional hazard analyses with adjustment for mortality risk were used to assess associations between antibiotics and mortality using time-dependent covariates.
A US Department of Veterans Affairs nursing home.
Ninety-four residents with advanced dementia who developed 109 episodes.
Survival, treatment, mortality risk, illness severity, fluid intake, and several other patient characteristics.
Ten-day mortality was 48%, and 6-month mortality was 74%. Antibiotics were used in 77% of episodes. Overall, antibiotics were not associated with mortality rate (Hazard Ratio [HR] 0.70, Confidence Interval [CI] 0.38-1.30); however, antibiotics were associated with reduced 10-day mortality rate (HR 0.51, CI, 0.30-0.87; rate after 10 days: 1.5, CI 0.42-5.2). Benefit from antibiotics was less likely with inadequate fluid intake, and when experiencing the first episode.
In our sample of male nursing home residents with advanced dementia and lower respiratory infection, mortality was substantial despite antibiotic treatment. Antibiotics prolonged life but in many cases only for several days. Treatment decisions should take into account that antibiotics may delay death but may also prolong the dying process, indicating a need for accurate prediction of mortality and study of characteristics that may alter effectiveness of antibiotics.
描述晚期痴呆患者下呼吸道感染的长期死亡率，并评估死亡率与抗生素治疗之间的关系；抗生素治疗的分配与死亡率风险无关，这比以前的多中心观察性研究中产生的偏倚关联的可能性更小。
前瞻性研究（2004-2009 年）。使用多级 Cox 比例风险分析，并根据死亡率进行调整，使用时变协变量来评估抗生素与死亡率之间的关系。
美国退伍军人事务部的一家疗养院。
94 名患有晚期痴呆症且患有 109 例下呼吸道感染的患者。
生存、治疗、死亡率风险、疾病严重程度、液体摄入量和其他几个患者特征。
10 天死亡率为 48%，6 个月死亡率为 74%。77%的患者使用了抗生素。总体而言，抗生素与死亡率无关（风险比 [HR] 0.70，置信区间 [CI] 0.38-1.30）；然而，抗生素与降低 10 天死亡率相关（HR 0.51，CI 0.30-0.87；第 10 天的死亡率：1.5，CI 0.42-5.2）。抗生素的获益在液体摄入不足和首次发作时不太可能。
在我们的研究样本中，患有晚期痴呆症和下呼吸道感染的男性疗养院居民死亡率很高，尽管接受了抗生素治疗。抗生素延长了生命，但在许多情况下，只能延长几天。治疗决策应考虑到抗生素可能会延迟死亡，但也可能会延长死亡过程，这表明需要准确预测死亡率，并研究可能改变抗生素有效性的特征。
