Department of Infectious Diseases, Hospital Universitari de Bellvitge - IDIBELL, Barcelona, Spain.
Clin Microbiol Infect. 2014 Sep;20(9):O531-7. doi: 10.1111/1469-0691.12524. Epub 2014 Feb 10.
Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p <0.001 and p <0.001, respectively). Bacteraemia was less frequent in pre-treated patients (p 0.01). The frequency of positive sputum culture and the sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP.
有关院前抗生素治疗对社区获得性肺炎（CAP）患者病原体、临床特征和结局影响的信息仍然有限。我们对 2003 年至 2012 年期间因 CAP 住院的非免疫抑制成年患者进行了一项前瞻性队列观察研究。患者分为两组：接受过同一次 CAP 院前抗生素治疗的患者和未接受过的患者。使用倾向评分进行患者匹配。在 2179 例连续 CAP 发作中，376 例（17.3%）发生在接受过院前抗生素治疗的患者中。经过倾向评分匹配后，与未接受过院前抗生素治疗的患者相比，接受过治疗的患者中更常发现嗜肺军团菌，而肺炎链球菌则较少见（p<0.001 和 p<0.001）。治疗组患者血培养阳性率较低（p<0.01）。两组患者痰培养阳性率、诊断肺炎链球菌性肺炎的尿抗原检测的敏感性和特异性相似。接受过院前抗生素治疗的患者发热（p<0.02）或白细胞增多（p<0.001）的频率较低。相反，这些患者的胸部 X 线空洞形成更为常见（p<0.04）。两组患者中，被归类为高风险肺炎严重指数（PSI）的患者频率、入住重症监护病房（ICU）的频率或 30 天死亡率无显著差异。总之，接受过院前抗生素治疗的患者中，嗜肺军团菌的发生率几乎是未接受治疗的患者的三倍。经过倾向评分调整分析，两组患者的预后无显著差异。在选择 CAP 患者的病因学诊断试验和经验性抗生素治疗时，应考虑使用院前抗生素。
