Uni Masahiro, Nishimura Naoki, Yamano Yasuhiko, Ishikawa Genta, Kitamura Atsushi, Tomishima Yutaka, Jinta Torahiko, Takahashi Osamu, Deshpande Gautam, Chohnabayashi Naohiko
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan.
Division of Pulmonary Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo City, Tokyo 104-8560, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Nishi-oiwake-cho 160, Seto City, Aichi Prefecture, Japan.
Respir Investig. 2015 Sep;53(5):225-31. doi: 10.1016/j.resinv.2015.04.004. Epub 2015 Aug 4.
Previous reports have documented the efficacy of an early switch from intravenous to oral antimicrobials in community-acquired pneumonia, but not aspiration pneumonia. Therefore, we assessed the feasibility and efficacy of these newly developed criteria for community-acquired pneumonia in patients with aspiration pneumonia.
This prospective observational study included consecutive patients admitted with aspiration pneumonia over a 10-month period at St. Luke's International Hospital; we excluded patients that required intensive care. The criteria for an early switch were stability of vital signs (temperature ≤ 38 °C; respiratory rate ≤ 24 breaths/min; pulse rate ≤ 100 beats/min for >24 h) and a successful swallow evaluation (repetitive saliva swallowing test score ≥ 2; modified water swallowing test score ≥ 4). Our primary endpoint was successful completion of antimicrobial treatment 30 days after the switch, without reversion to intravenous antimicrobials. Our anticipated success rate was set as 60-75%, based on a previous study.
Of the 70 patients admitted with aspiration pneumonia, 32 (45.7%) were excluded, and 38 (54.3%) met the inclusion criteria. Of these 38 patients, 29 (76.3%) met the switch criteria. The median duration of hospital stay for the included patients was 16 (5-30) days and 30 (12-68) days, respectively (P=0.03). Among patients who met the switch criteria, 26 (89.7%) completed oral treatment successfully while 3 (10.3%) reverted to intravenous antimicrobials.
Approximately 75% of patients met the switch criteria; of these, nearly 90% underwent safe conversion to oral therapy. These results demonstrate the efficacy and feasibility of our switch criteria.
既往报道已证实社区获得性肺炎患者早期从静脉使用抗菌药物转换为口服抗菌药物的有效性，但吸入性肺炎患者的相关情况尚未见报道。因此，我们评估了这些新制定的社区获得性肺炎标准在吸入性肺炎患者中的可行性和有效性。
这项前瞻性观察性研究纳入了圣路加国际医院10个月期间连续收治的吸入性肺炎患者；我们排除了需要重症监护的患者。早期转换的标准为生命体征稳定（体温≤38℃；呼吸频率≤24次/分钟；心率≤100次/分钟且持续>24小时）以及吞咽评估成功（重复唾液吞咽试验评分≥2；改良水吞咽试验评分≥4）。我们的主要终点是转换后30天抗菌治疗成功完成，且未恢复静脉使用抗菌药物。根据既往研究，我们预期的成功率设定为60 - 75%。
70例吸入性肺炎患者中，32例（45.7%）被排除，38例（54.3%）符合纳入标准。在这38例患者中，29例（76.3%）符合转换标准。纳入患者的住院中位时间分别为16（5 - 30）天和30（12 - 68）天（P = 0.03）。在符合转换标准的患者中，26例（89.7%）成功完成口服治疗，3例（10.3%）恢复静脉使用抗菌药物。
约75%的患者符合转换标准；其中近90%安全转换为口服治疗。这些结果证明了我们转换标准的有效性和可行性。
