Frei Christopher R, Rehani Sylvie, Lee Grace C, Boyd Natalie K, Attia Erene, Pechal Ashley, Britt Rachel S, Mortensen Eric M
Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas.
Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Pharmacotherapy. 2017 Feb;37(2):195-203. doi: 10.1002/phar.1891. Epub 2017 Feb 3.
To assess the impact of empiric Pseudomonas pharmacotherapy on 30-day mortality in hospitalized patients with community-onset pneumonia stratified according to their risk (low, medium, or high) of drug-resistant pathogens.
Retrospective cohort study.
Veterans Health Administration database.
A total of 50,119 patients who were at least 65 years of age, hospitalized with pneumonia, and received antibiotics within 48 hours of admission between fiscal years 2002 and 2007. Patients were stratified into empiric Pseudomonas therapy (31,027 patients) and no Pseudomonas therapy (19,092 patients) groups based on antibiotics received during their first 48 hours of admission.
A clinical prediction scoring system developed in 2014 that stratifies patients with community-onset pneumonia according to their risk of drug-resistant pathogens was used to identify patients who were likely to benefit from empiric Pseudomonas therapy as well as those in whom antipseudomonal therapy could be spared; patients were classified into low-risk (68%), medium-risk (21%), and high-risk (11%) groups. Of the 50,119 patients, 62% received Pseudomonas therapy. All-cause 30-day mortality was the primary outcome. Empiric Pseudomonas therapy (adjusted odds ratio 0.72, 95% confidence interval 0.62-0.84) was associated with lower 30-day mortality in the high-risk group but not the low- or medium-risk groups.
Application of a risk score for patients with drug-resistant pathogens can identify patients likely to benefit from empiric Pseudomonas therapy. Widespread use of this score could reduce overuse of anti-Pseudomonas antibiotics in low- to medium-risk patients and improve survival in high-risk patients.
评估经验性抗假单胞菌药物治疗对社区获得性肺炎住院患者30天死亡率的影响，这些患者根据其感染耐药病原体的风险（低、中或高）进行分层。
回顾性队列研究。
退伍军人健康管理局数据库。
共有50119例年龄至少65岁、因肺炎住院且在2002财年至2007财年入院48小时内接受抗生素治疗的患者。根据入院后最初48小时内接受的抗生素治疗情况，将患者分为经验性抗假单胞菌治疗组（31027例患者）和非抗假单胞菌治疗组（19092例患者）。
使用2014年开发的一种临床预测评分系统，该系统根据社区获得性肺炎患者感染耐药病原体的风险对其进行分层，以识别可能从经验性抗假单胞菌治疗中获益的患者以及可以避免抗假单胞菌治疗的患者；患者被分为低风险组（68%）、中风险组（21%）和高风险组（11%）。在50119例患者中，62%接受了抗假单胞菌治疗。全因30天死亡率是主要结局。经验性抗假单胞菌治疗（调整后的优势比为0.72，95%置信区间为0.62 - 0.84）与高风险组较低的30天死亡率相关，但与低风险组或中风险组无关。
应用针对耐药病原体患者的风险评分可以识别可能从经验性抗假单胞菌治疗中获益的患者。广泛使用该评分可以减少低至中风险患者对抗假单胞菌抗生素的过度使用，并提高高风险患者的生存率。
