Llop Christopher J, Tuttle Edward, Tillotson Glenn S, LaPlante Kerry, File Thomas M
a Analysis Group, Inc. , Boston , MA , USA.
b Analysis Group, Inc. , Menlo Park , CA , USA.
Hosp Pract (1995). 2017 Feb;45(1):1-8. doi: 10.1080/21548331.2017.1279012. Epub 2017 Jan 18.
The current treatment options for patients with community-acquired pneumonia (CAP) often present a trade-off between the potential for treatment failure and safety concerns. We set out to investigate real-world outcomes associated with the use of currently available antimicrobial treatment options for CAP in both the outpatient and inpatient (non-intensive care unit [ICU]) settings.
This claims-based retrospective study included adult patients diagnosed with CAP and treated with antibiotic therapies, including any oral fluoroquinolone, macrolide, or beta-lactam monotherapy in the outpatient setting, and intravenous (IV) levofloxacin or IV azithromycin/ceftriaxone in the inpatient setting. Generalized linear model (GLM) regression was used to determine total charges for inpatient stay, the length of stay, and days of inpatient therapy. For outpatients, rates of adverse events (AEs), treatment failure, and hospitalization were compared by type of initial antibiotic therapy using logistic regression multivariate models that controlled for baseline characteristics.
A total of 441,820 outpatients and 33,287 inpatients treated for CAP between 2007 and 2012 were included in this analysis. In the outpatient setting, fluoroquinolone therapy led to a higher rate of documented AEs (adjusted odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.20-1.25; p < 0.0001) but a lower rate of retreatment (adjusted OR: 0.9; 95% CI: 0.87-0.94; p < 0.0001) compared with macrolides. Both AEs and retreatment in these patients were associated with increased costs. For patients treated with the IV macrolide/beta-lactam combination compared with IV fluoroquinolone in the inpatient setting, a significantly longer length of stay in hospital (4.71 vs. 4.38 days; p < 0.0001) and greater overall costs ($3,535 more per stay; p < 0.0001) were observed.
In both the inpatient and outpatient settings, the development of additional efficacious treatment options that have a reduced AE burden for patients with CAP may be warranted.
社区获得性肺炎（CAP）患者目前的治疗选择常常需要在治疗失败风险和安全性问题之间进行权衡。我们着手调查在门诊和住院（非重症监护病房[ICU]）环境中使用目前可用的CAP抗菌治疗方案所产生的实际治疗效果。
这项基于索赔数据的回顾性研究纳入了诊断为CAP并接受抗生素治疗的成年患者，门诊治疗包括任何口服氟喹诺酮类、大环内酯类或β-内酰胺类单药治疗，住院治疗包括静脉注射（IV）左氧氟沙星或IV阿奇霉素/头孢曲松。采用广义线性模型（GLM）回归来确定住院总费用、住院时间和住院治疗天数。对于门诊患者，使用控制基线特征的逻辑回归多变量模型，按初始抗生素治疗类型比较不良事件（AE）发生率、治疗失败率和住院率。
本分析纳入了2007年至2012年间接受CAP治疗的441,820名门诊患者和33,287名住院患者。在门诊环境中，与大环内酯类相比，氟喹诺酮类治疗导致记录在案的AE发生率更高（调整优势比[OR]：1.23；95%置信区间[CI]：1.20 - 1.25；p < 0.0001），但再次治疗率更低（调整OR：0.9；95% CI：0.87 - 0.94；p < 0.0001）。这些患者的AE和再次治疗均与费用增加相关。在住院环境中，与IV氟喹诺酮类相比，接受IV大环内酯类/β-内酰胺类联合治疗的患者住院时间显著更长（4.71天对4.38天；p < 0.0001），总体费用更高（每次住院多3535美元；p < 0.0001）。
在住院和门诊环境中，开发对CAP患者减轻AE负担的额外有效治疗方案可能是有必要的。
