Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Respir Med. 2012 Mar;106(3):451-8. doi: 10.1016/j.rmed.2011.11.017. Epub 2011 Dec 17.
For outpatients with pneumonia, guidelines recommend empiric antibiotics and some suggest macrolides are preferred agents. We hypothesized that both guideline-concordant antibiotics and macrolides would be associated with reduced mortality.
All outpatients with pneumonia assessed at 7 Emergency Departments in Edmonton, Alberta, Canada were enrolled in a population-based registry that included clinical-radiographic data, Pneumonia Severity Index (PSI) and treatments. Guideline-concordant regimens included macrolides and respiratory fluoroquinolones; other regimens were "discordant". Main outcome was 30-day all-cause mortality.
The study included 2973 outpatients; mean age 51 years, 47% female, most had mild pneumonia (73% PSI Class I-II). Over 30-days, 38 (1%) patients died, 228 (8%) were hospitalized, and 253 (9%) reached the endpoint of death or hospitalization. Most (2845 [96%]) patients received guideline-concordant antibiotics. Compared to patients receiving discordant antibiotics, those receiving guideline-concordant antibiotics were less likely to die within 30-days (8 [6%] versus 30 [1%], adjusted OR 0.23, 95% CI 0.09-0.59, p = 0.002). Within the guideline-concordant subgroup, compared to the 947 (33%) patients treated with fluoroquinolones, those receiving macrolides [1847 (64%)] were less likely to die (25 [3%] versus 4 [0.2%], adjusted OR 0.28, 95% CI 0.09-0.86, p = 0.03).
In outpatients with pneumonia, treatment with guideline-concordant antibiotics and macrolides were both associated with mortality reduction.
对于门诊肺炎患者，指南推荐使用经验性抗生素，有些建议首选大环内酯类药物。我们假设，无论是符合指南的抗生素还是大环内酯类药物都与死亡率降低有关。
在加拿大阿尔伯塔省埃德蒙顿的 7 家急诊部评估的所有门诊肺炎患者都被纳入了一个基于人群的登记处，该登记处包括临床影像学数据、肺炎严重指数（PSI）和治疗方法。符合指南的方案包括大环内酯类药物和呼吸氟喹诺酮类药物；其他方案为“不一致”。主要结局为 30 天全因死亡率。
该研究纳入了 2973 名门诊患者；平均年龄 51 岁，47%为女性，大多数为轻度肺炎（PSI Ⅰ-Ⅱ级 73%）。在 30 天内，38 名（1%）患者死亡，228 名（8%）住院，253 名（9%）达到死亡或住院的终点。大多数（2845 名[96%]）患者接受了符合指南的抗生素治疗。与使用不一致抗生素的患者相比，使用符合指南的抗生素的患者在 30 天内死亡的可能性较小（8 [6%] 例与 30 [1%] 例，调整后的 OR 0.23，95%CI 0.09-0.59，p=0.002）。在符合指南的亚组内，与接受氟喹诺酮类药物治疗的 947 名（33%）患者相比，接受大环内酯类药物治疗的患者[1847 名（64%）]死亡的可能性较小（25 [3%] 例与 4 [0.2%] 例，调整后的 OR 0.28，95%CI 0.09-0.86，p=0.03）。
在门诊肺炎患者中，使用符合指南的抗生素和大环内酯类药物治疗均与死亡率降低有关。
