Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Ciber de Enfermedades Respiratorias (CIBERES), Hospital Clinic, Barcelona, Spain.
Infection. 2013 Apr;41(2):361-70. doi: 10.1007/s15010-012-0316-8. Epub 2012 Aug 21.
Several studies have analyzed factors associated to hospitalization in chronic obstructive pulmonary disease (COPD) patients. However, data are lacking on the quality of treatment received by patients prior to hospital admission. The present study analyzed how often patients requiring hospitalization for a COPD exacerbation had received previous treatment for the exacerbation, particularly antibiotics.
This was a multicenter, cross-sectional, observational study conducted in 30 Spanish hospitals among COPD patients aged >40 years who were hospitalized for an acute exacerbation. Patients were grouped according to whether or not they had received treatment prior to admission and, subsequently, according to whether or not they had received antibiotics. Patient eligibility for antibiotic therapy was assessed using both national and European guidelines.
The study population consisted of 298 patients, of which 277 (93 %) were men, with a mean [standard deviation (SD)] age of 69.1 (9.5) years. One hundred and thirty-three patients (45 %) had received treatment prior to admission; among these, 76/133 (57 %) had received antibiotic therapy. However, 81-91 % of these patients fulfilled criteria for this therapy. Antibiotic use was significantly associated with yellow or green-yellow sputum prior to the exacerbation, a higher number of exacerbations in the previous year, more visits to emergency departments, and bronchiectasis. On the other hand, 10-20 % of patients who did receive antibiotics were not eligible for this therapy according to guidelines.
This study demonstrates a low rate of previous outpatient treatment and antibiotic use among patients with a COPD exacerbation requiring hospital admission.
多项研究分析了与慢性阻塞性肺疾病（COPD）患者住院相关的因素。然而，关于患者在入院前接受治疗的质量的数据尚缺乏。本研究分析了需要因 COPD 加重而住院的患者之前接受过多少次针对加重的治疗，特别是抗生素治疗。
这是一项在西班牙 30 家医院进行的多中心、横断面、观察性研究，纳入了因急性加重而住院的年龄>40 岁的 COPD 患者。根据患者入院前是否接受治疗以及是否接受抗生素治疗将患者分组。使用国家和欧洲指南评估患者接受抗生素治疗的资格。
研究人群由 298 例患者组成，其中 277 例（93%）为男性，平均（标准差）年龄为 69.1（9.5）岁。133 例（45%）患者在入院前接受了治疗；其中 76/133（57%）接受了抗生素治疗。然而，这些患者中有 81-91%符合该治疗的标准。抗生素的使用与加重前的黄痰或黄绿色痰、前一年发生的加重次数更多、更多次去急诊就诊以及支气管扩张症显著相关。另一方面，根据指南，10-20%接受抗生素治疗的患者不符合该治疗标准。
本研究表明，需要住院治疗的 COPD 加重患者在入院前接受门诊治疗和抗生素治疗的比例较低。
