van de Garde Ewoudt M W, Natsch Stephanie, Prins Jan M, van der Linden Paul D
Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands Divison of Pharmacoepidemiology & Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
BMJ Open. 2015 Feb 12;5(2):e006892. doi: 10.1136/bmjopen-2014-006892.
Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the outpatient to inpatient transition and the subsequent clinical course.
Retrospective cohort study.
Dutch PHARMO Record Linkage System.
7323 patients aged >18 years and hospitalised with pneumonia in the Netherlands between 2004 and 2010.
We identified all prescribed antibiotics prior to, during and after hospitalisation. In case of prior outpatient treatment, the continuation of antibiotic treatment on admission was categorised as: no atypical coverage > no atypical coverage; atypical coverage > atypical coverage; no atypical coverage > atypical coverage; and atypical coverage > no atypical coverage.
Length of hospital stay, in-hospital mortality and readmission within 30 days.
Twenty-two per cent of the patients had received prior outpatient treatment, of which 408 (25%) patients were switched on admission to antibiotics with atypical coverage. There were no differences in length of hospital stay, in-hospital mortality or readmission rate between the four categories of patients with prior outpatient treatment. The adjusted HR for adding atypical coverage versus no atypical coverage was 0.91 (95% CI 0.55 to 1.51) for time to discharge. For in-hospital mortality and readmission within 30 days, the adjusted ORs were 1.09 (95% CI 0.85 to 1.34) and 0.59 (95% CI 0.30 to 1.18), respectively.
This study found no association between mode of continuing antibiotic treatment at the outpatient to inpatient transition and relevant clinical outcomes. In particular, adding atypical coverage in patients without prior atypical coverage did not influence the outcome.
大多数肺炎治疗指南建议，在制定住院抗生素治疗方案时应考虑患者先前的门诊抗生素治疗情况。我们的目的是研究社区获得性肺炎住院患者从门诊到住院过渡期间继续使用抗生素治疗的方式以及随后的临床病程。
回顾性队列研究。
荷兰药物记录链接系统。
2004年至2010年间在荷兰住院治疗肺炎的7323名年龄大于18岁的患者。
我们确定了患者住院前、住院期间和住院后的所有处方抗生素。如果患者先前接受过门诊治疗，住院时抗生素治疗的延续情况分为：无非典型病原体覆盖→无非典型病原体覆盖；有非典型病原体覆盖→有非典型病原体覆盖；无非典型病原体覆盖→有非典型病原体覆盖；有非典型病原体覆盖→无非典型病原体覆盖。
住院时间、住院死亡率和30天内再入院率。
22%的患者先前接受过门诊治疗，其中408名（25%）患者住院时改用了覆盖非典型病原体的抗生素。在先前接受门诊治疗的四类患者中，住院时间、住院死亡率或再入院率没有差异。出院时间方面，添加非典型病原体覆盖与不添加非典型病原体覆盖相比，校正后的风险比为0.91（95%可信区间0.55至1.51）。住院死亡率和30天内再入院率的校正比值比分别为1.09（95%可信区间0.85至1.34）和0.59（95%可信区间0.30至1.18）。
本研究发现，从门诊到住院过渡期间继续使用抗生素治疗的方式与相关临床结局之间没有关联。特别是，在先前未覆盖非典型病原体的患者中添加非典型病原体覆盖对结局没有影响。
