University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA.
Respir Care. 2013 Sep;58(9):1489-94. doi: 10.4187/respcare.02191. Epub 2013 Jan 23.
Limited information is available regarding the impact of prior use of inhaled corticosteroids (ICS) in patients subsequently developing community-acquired pneumonia (CAP). We assessed the effects of prior ICS use on severity of illness and microbiology in CAP hospitalized patients.
A retrospective cohort study of subjects with CAP (by the International Classification of Diseases, 9th Revision, Clinical Modification) was conducted over a 4-year period at 2 tertiary teaching hospitals. Subjects were considered to be ICS users if they received ICS prior to admission. Primary outcomes were severity of illness and microbiology at admission.
Data were abstracted on 664 subjects: 89 prior ICS users (13.4%) and 575 non-users (86.6%). Prior ICS users had higher severity of illness at admission: mean ± SD Pneumonia Severity Index 100.8 ± 31.4 vs 68.8 ± 33.4, P = .001, and CURB-65 (confusion, urea nitrogen, respiratory rate, blood pressure, ≥ 65 years of age) score 1.56 ± 1.02 vs 1.19 ± 1.02, P = .002. Prior ICS use was independently associated with antimicrobial-resistant pathogens: 11.2% vs 5.9%, odds ratio 2.6, 95% CI 1.1-6.1, P = .04.
Prior ICS use was associated with higher severity of illness at admission and higher incidence of antimicrobial-resistant pathogens in CAP hospitalized patients.
关于先前使用吸入性皮质类固醇（ICS）的患者随后发展为社区获得性肺炎（CAP）的影响，信息有限。我们评估了先前使用 ICS 对 CAP 住院患者疾病严重程度和微生物学的影响。
对 2 家三级教学医院 4 年内 CAP（采用国际疾病分类，第 9 版，临床修正）患者进行回顾性队列研究。如果患者在入院前接受 ICS，则认为他们是 ICS 使用者。主要结局是入院时的疾病严重程度和微生物学。
共提取了 664 例患者的数据：89 例先前 ICS 使用者（13.4%）和 575 例非使用者（86.6%）。先前 ICS 使用者入院时疾病严重程度更高：平均 ± 标准差肺炎严重指数为 100.8 ± 31.4 与 68.8 ± 33.4，P =.001，CURB-65（意识模糊、尿素氮、呼吸频率、血压、年龄≥65 岁）评分 1.56 ± 1.02 与 1.19 ± 1.02，P =.002。先前 ICS 使用与抗微生物药物耐药病原体独立相关：11.2%比 5.9%，比值比 2.6，95%置信区间 1.1-6.1，P =.04。
先前 ICS 使用与 CAP 住院患者入院时疾病严重程度增加和抗微生物药物耐药病原体发生率增加相关。
