Department of Medicine, the Division of Infectious Diseases, University of Colorado Denver, Aurora, CO, USA.
Acad Emerg Med. 2012 Jun;19(6):703-6. doi: 10.1111/j.1553-2712.2012.01365.x. Epub 2012 May 25.
Due to antimicrobial resistance in Streptococcus pneumoniae, national guidelines recommend a respiratory fluoroquinolone or combination antimicrobial therapy for outpatient treatment of community-acquired pneumonia (CAP) associated with risk factors for drug-resistant S. pneumoniae (DRSP). The objectives of this study were to assess the prevalence of these risk factors and antibiotic prescribing practices in cases of outpatient CAP treated in the acute care setting.
This was a retrospective cohort study of adult outpatients treated for CAP in the emergency department (ED) or urgent care center of an urban, academic medical center from May 1, 2009, through October 31, 2009, and comparison of antibiotic therapy in cases with and without DRSP risk factors.
Of 175 patients, 90 (51%) had at least one DRSP risk factor, most commonly asthma (n = 28, 16%), alcohol abuse (n = 24, 14%), diabetes mellitus (n = 18, 10%), chronic obstructive pulmonary disease (n = 16, 9%), age > 65 years (n = 16, 9%), and use of antibiotics within 3 months (15, 9%). Antibiotic prescriptions were similar among cases with and without DRSP risk factors: a macrolide (62% vs. 59%, respectively, p = 0.65), doxycycline (27% vs. 28%, p = 0.82), or a respiratory fluoroquinolone (9% vs. 9%, p = 0.90). Concordance with national guideline treatment recommendations was significantly lower in cases with DRSP risk factors (9% vs. 87%, p < 0.0001).
DRSP risk factors were present in approximately half of outpatient CAP cases treated in the acute care setting; however, guideline-concordant antibiotic therapy was infrequent. Strict adherence to current guidelines would substantially increase use of fluoroquinolones or combination therapy. Whether the potential risks associated with these broad-spectrum regimens are justified by improved clinical outcomes requires further study.
由于肺炎链球菌对抗生素的耐药性，国家指南建议对伴有耐药肺炎链球菌（DRSP）风险因素的社区获得性肺炎（CAP）患者采用呼吸氟喹诺酮类药物或联合抗菌疗法进行门诊治疗。本研究的目的是评估在急性护理环境中治疗门诊 CAP 时这些风险因素的流行情况和抗生素处方实践。
这是一项回顾性队列研究，纳入了 2009 年 5 月 1 日至 2009 年 10 月 31 日期间在城市学术医疗中心的急诊室（ED）或紧急护理中心接受 CAP 治疗的成年门诊患者，并比较了伴有和不伴有 DRSP 风险因素的患者的抗生素治疗情况。
在 175 例患者中，90 例（51%）至少存在一种 DRSP 风险因素，最常见的是哮喘（n=28，16%）、酗酒（n=24，14%）、糖尿病（n=18，10%）、慢性阻塞性肺疾病（n=16，9%）、年龄>65 岁（n=16，9%）和在 3 个月内使用抗生素（n=15，9%）。伴有和不伴有 DRSP 风险因素的患者的抗生素处方相似：大环内酯类（62%与 59%，p=0.65）、多西环素（27%与 28%，p=0.82）或呼吸氟喹诺酮类（9%与 9%，p=0.90）。伴有 DRSP 风险因素的患者与国家指南治疗推荐的一致性明显较低（9%与 87%，p<0.0001）。
在急性护理环境中治疗的门诊 CAP 病例中，约有一半存在 DRSP 风险因素；然而，符合指南的抗生素治疗并不常见。严格遵循当前指南将大大增加氟喹诺酮类药物或联合治疗的使用。这些广谱方案相关的潜在风险是否通过改善临床结局得到证明，还需要进一步研究。
