van der Maaden Tessa, Hendriks Simone A, de Vet Henrica C W, Zomerhuis Menno T, Smalbrugge Martin, Jansma Elise P, Koopmans Raymond T C M, Hertogh Cees M P M, van der Steen Jenny T
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands,
Drugs Aging. 2015 Jan;32(1):43-56. doi: 10.1007/s40266-014-0223-z.
Infections frequently occur in patients with dementia and antibiotics are often prescribed, but may also be withheld.
The aim of this systematic review is to provide a systematic overview of the prevalence of antibiotic use, and factors associated with prescribing antibiotics in patients with dementia.
A systematic search of MEDLINE, EMBASE, PSYCINFO, CINAHL, and the Cochrane library databases until February 13, 2014 was performed, using both controlled terms and free-text terms.
Thirty-seven articles were included. The point prevalence of antibiotic use in patients with dementia ranged from 3.3 to 16.6%. The period prevalence ranged from 4.4 to 88% overall, and from 23.5 to 94% in variable time frames before death; the median use was 52% (median period 14 days) and 48% (median period 22 days), respectively. Most patients with lower respiratory tract infections or urinary tract infections (77-91%) received antibiotic treatment. Factors associated with antibiotic use related to patients, families, physicians, and the healthcare context. More severe dementia and a poor prognosis were associated with less antibiotic use in various countries. Associations with aspiration and illness severity differed by country.
Antibiotic use in patients with dementia is substantial, and probably highly associated with the particular healthcare context. Future studies may report antibiotic use by infection type and stage of dementia, and compare cross-nationally.
痴呆患者经常发生感染，抗生素常被处方使用，但也可能被停用。
本系统评价的目的是系统概述痴呆患者抗生素使用的患病率以及与抗生素处方相关的因素。
使用控制词和自由文本词对MEDLINE、EMBASE、PSYCINFO、CINAHL和Cochrane图书馆数据库进行系统检索，截至2014年2月13日。
纳入37篇文章。痴呆患者抗生素使用的时点患病率为3.3%至16.6%。总体期间患病率为4.4%至88%，在死亡前的不同时间段内为23.5%至94%；中位数使用分别为52%（中位数时间段14天）和48%（中位数时间段22天）。大多数下呼吸道感染或尿路感染患者（77%-91%）接受了抗生素治疗。与抗生素使用相关的因素涉及患者、家庭、医生和医疗环境。在各个国家，更严重的痴呆和不良预后与较少的抗生素使用相关。与误吸和疾病严重程度的关联因国家而异。
痴呆患者抗生素使用情况较为普遍，且可能与特定的医疗环境高度相关。未来的研究可以按感染类型和痴呆阶段报告抗生素使用情况，并进行跨国比较。
