氟喹诺酮类药物与β-内酰胺/β-内酰胺酶抑制剂用于慢性阻塞性肺疾病合并肺炎门诊患者的疗效比较：一项基于全国人口的研究

Fluoroquinolones versus β-Lactam/β-Lactamase Inhibitors in Outpatients with Chronic Obstructive Pulmonary Disease and Pneumonia: A Nationwide Population-Based Study.

作者信息

Lin Kuan-Yin, Wang Chi-Chuan, Lin Chia-Hui, Sheng Wang-Huei, Chang Shan-Chwen

机构信息

Center for Drug Evaluation, Taipei, Taiwan.

School of Pharmacy, National Taiwan University, Taipei, Taiwan.

出版信息

PLoS One. 2015 Aug 25;10(8):e0136232. doi: 10.1371/journal.pone.0136232. eCollection 2015.

DOI:10.1371/journal.pone.0136232

PMID:26305908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4549331/

Abstract

BACKGROUND

Studies on the association between antibiotic treatment and outcomes in outpatients with chronic obstructive pulmonary disease (COPD) and pneumonia are scarce. This study aimed to evaluate the effectiveness of fluoroquinolones and β-lactam/β-lactamase inhibitors for pneumonia in COPD outpatients.

METHODS

We conducted a retrospective cohort study and identified 4,851 episodes of pneumonia among COPD outpatients treated with fluoroquinolones or β-lactam/β-lactamase inhibitors from the Taiwan National Health Insurance Research Database during 2002-2011. Using the propensity score analysis, 1,296 pairs of episodes were matched for the demographic and clinical characteristics. The primary outcome was pneumonia/empyema-related hospitalization or emergency department (ED) visits, and the secondary outcomes were treatment failure, all-cause mortality and medical costs within 30 days.

RESULTS

Compared with episodes treated with β-lactam/β-lactamase inhibitors, episodes treated with fluoroquinolones had similar clinical outcomes. The rates of pneumonia/empyema-related hospitalization or ED visits were 3.9% and 3.5% in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively (adjusted hazard ratio [aHR], 1.11; 95% confidence interval [CI], 0.74-1.66). The percentage of treatment failure and all-cause mortality were 28.2% versus 31.3% (adjusted odds ratio, 0.86; 95% CI, 0.73-1.02) and 0.5% versus 0.4% (aHR, 1.40; 95% CI, 0.45-4.41) in the fluoroquinolone and β-lactam/β-lactamase inhibitor groups, respectively. The medical expenditures, including total medical costs (528 versus 455 US dollars) and pneumonia-related costs (202 vs. 155 USD) were also balanced between the two treatment groups (both P >0.05).

CONCLUSIONS

For pneumonia in COPD outpatients, fluoroquinolones were associated with similar clinical outcomes and medical expenditures compared with β-lactam/β-lactamase inhibitors.

摘要

背景

关于抗生素治疗与慢性阻塞性肺疾病（COPD）门诊患者肺炎预后之间关联的研究较少。本研究旨在评估氟喹诺酮类药物和β-内酰胺/β-内酰胺酶抑制剂对COPD门诊患者肺炎的疗效。

方法

我们进行了一项回顾性队列研究，从台湾国民健康保险研究数据库中识别出2002年至2011年期间接受氟喹诺酮类药物或β-内酰胺/β-内酰胺酶抑制剂治疗的COPD门诊患者中的4851例肺炎发作。采用倾向得分分析，对1296对发作病例的人口统计学和临床特征进行匹配。主要结局是肺炎/脓胸相关的住院或急诊科就诊，次要结局是治疗失败、全因死亡率和30天内的医疗费用。

结果

与接受β-内酰胺/β-内酰胺酶抑制剂治疗的发作病例相比，接受氟喹诺酮类药物治疗的发作病例临床结局相似。氟喹诺酮组和β-内酰胺/β-内酰胺酶抑制剂组肺炎/脓胸相关的住院或急诊科就诊率分别为3.9%和3.5%（调整后风险比[aHR]，1.11；95%置信区间[CI]，0.74 - 1.66）。氟喹诺酮组和β-内酰胺/β-内酰胺酶抑制剂组的治疗失败百分比和全因死亡率分别为28.2%对31.3%（调整后优势比，0.86；95% CI，0.73 - 1.02）和0.5%对0.4%（aHR，1.40；95% CI，0.45 - 4.41）。两个治疗组之间的医疗支出，包括总医疗费用（528美元对455美元）和肺炎相关费用（202美元对155美元）也相当（均P>0.05）。