Policy Analysis, Inc. (AB, JE, GO), Brookline, Massachusetts; Health Economics and Outcomes Research, Forest Research Institute, Inc. (XH), Jersey City, New Jersey; and Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine (DJW), Chapel Hill, North Carolina.
Am J Med Sci. 2014 May;347(5):347-56. doi: 10.1097/MAJ.0b013e318294833f.
Although clinical guidelines for management of community-acquired pneumonia (CAP) in non-intensive care unit ("non-ICU") hospitalized patients have changed substantially over the last decade, it is unknown how treatment of this disease has evolved over this period.
Using data from >100 U.S. hospitals, we identified all adults (aged ≥18 years) hospitalized for CAP between January 1, 2000, and June 30, 2009 ("study period"). We excluded patients admitted to ICU <24 hours of admission, those not starting antibiotics <24 hours of admission, those not receiving antibiotics for ≥48 hours (if alive), and those with probable healthcare-associated pneumonia. We defined "initial therapy" as all parenteral antibiotics received ≤24 hours of admission, and we examined changes in such therapy over the study period. The statistical significance of changes in initial therapy was ascertained using 2-tailed χ tests.
We identified 40,392 patients who met all selection criteria. In 2000, the most frequently used initial regimens were levofloxacin (24.0% of all such admissions), ceftriaxone (9.0%), cefotaxime (7.3%), ceftriaxone plus levofloxacin (3.2%) and azithromycin plus cefotaxime (3.0%); in 2009, they were ceftriaxone plus azithromycin (18.5%), levofloxacin (12.7%), ceftriaxone (6.6%), moxifloxacin (4.7%) and ceftriaxone + levofloxacin (3.2%). Use of single-agent regimens declined between 2000 and 2009 (from 48.2%-30.0%); use of vancomycin almost doubled (13.1%-23.3%). All findings were statistically significant (P < 0.01).
Initial antibiotic therapy for non-ICU CAP has changed substantially in the United States over the past decade, in line with evidence of widespread antibiotic resistance, evolving treatment guidelines and, most recently, quality improvement initiatives that tie hospital payments to guideline-based care.
尽管近十年来，非重症监护病房（非 ICU）住院患者社区获得性肺炎（CAP）管理的临床指南发生了重大变化，但尚不清楚在此期间该病的治疗方法是如何演变的。
我们利用来自美国 100 多家医院的数据，确定了 2000 年 1 月 1 日至 2009 年 6 月 30 日期间所有因 CAP 住院的成年人（年龄≥18 岁）。我们排除了 ICU 入院时间<24 小时、入院时间<24 小时未开始使用抗生素、未接受抗生素治疗≥48 小时（如存活）和可能与医疗保健相关的肺炎患者。我们将“初始治疗”定义为入院≤24 小时内接受的所有静脉用抗生素，并检查了研究期间该治疗方法的变化。使用双侧 χ2 检验确定初始治疗变化的统计学意义。
我们确定了符合所有入选标准的 40392 名患者。2000 年，最常用的初始治疗方案是左氧氟沙星（所有此类入院患者的 24.0%）、头孢曲松（9.0%）、头孢噻肟（7.3%）、头孢曲松加左氧氟沙星（3.2%）和阿奇霉素加头孢噻肟（3.0%）；2009 年，它们是头孢曲松加阿奇霉素（18.5%）、左氧氟沙星（12.7%）、头孢曲松（6.6%）、莫西沙星（4.7%）和头孢曲松+左氧氟沙星（3.2%）。2000 年至 2009 年期间，单一药物治疗方案的使用率从 48.2%下降至 30.0%（P<0.01）；万古霉素的使用率几乎翻了一番（从 13.1%升至 23.3%）。所有发现均具有统计学意义（P<0.01）。
近十年来，美国非 ICU CAP 的初始抗生素治疗发生了重大变化，这与广泛的抗生素耐药性、不断发展的治疗指南以及最近将医院支付与基于指南的护理挂钩的质量改进举措相一致。
