Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland.
Department of Internal Medicine, Hôpital Neuchâtelois and Geneva University Hospitals, Switzerland.
Eur J Intern Med. 2017 Sep;43:58-61. doi: 10.1016/j.ejim.2017.06.012. Epub 2017 Jun 23.
The association between early antibiotic administration and outcomes remains controversial in patients hospitalized for community-acquired pneumonia.
We performed a secondary analysis of a randomized controlled trial comparing two antibiotic treatment strategies for patients hospitalized for moderately severe CAP. The univariate and multivariate associations between time to antibiotic administration (TTA) and time to clinical stability were assessed using a Cox proportional hazard model. Secondary outcomes were death, intensive care unit admission and hospital readmission up to 90days.
371 patients (mean age 76years, CURB-65 score≥2 in 52%) were included. Mean TTA was 4.35h (SD 3.48), with 58.5% of patients receiving the first antibiotic dose within 4h. In multivariate analysis, number of symptoms and signs (HR 0.876, 95% CI 0.784-0.979, p=0.020), age (HR 0.986, 95% CI 0.975-0.996, p=0.007), initial heart rate (HR 0.992, 95% CI 0.986-0.999, p=0.023), and platelets count (HR 0.998, 95% CI 0.996-0.999, p=0.004) were associated with a reduced probability of reaching clinical stability. The association between TTA and time to clinical stability was not significant (HR 1.009, 95% CI 0.977-1.042, p=0.574). We found no association between TTA and the risk of intensive care unit admission, death or readmission up to 90days after the initial admission.
In patients hospitalized for moderately severe CAP, a shorter time to antibiotic administration was not associated with a favorable outcome. These findings support the current recommendations that do not assign a specific time frame for antibiotics administration.
在因社区获得性肺炎住院的患者中，早期给予抗生素与结局之间的关系仍存在争议。
我们对一项比较两种抗生素治疗策略的随机对照试验进行了二次分析，该试验纳入了因中度严重 CAP 住院的患者。使用 Cox 比例风险模型评估抗生素给药时间（TTA）与临床稳定时间之间的单变量和多变量关联。次要结局为 90 天内的死亡、入住重症监护病房和医院再入院。
共纳入 371 例患者（平均年龄 76 岁，CURB-65 评分≥2 占 52%）。平均 TTA 为 4.35 小时（SD 3.48），58.5%的患者在 4 小时内给予首剂抗生素。多变量分析中，症状和体征的数量（HR 0.876，95%CI 0.784-0.979，p=0.020）、年龄（HR 0.986，95%CI 0.975-0.996，p=0.007）、初始心率（HR 0.992，95%CI 0.986-0.999，p=0.023）和血小板计数（HR 0.998，95%CI 0.996-0.999，p=0.004）与临床稳定的可能性降低相关。TTA 与临床稳定时间之间的关联无统计学意义（HR 1.009，95%CI 0.977-1.042，p=0.574）。我们未发现 TTA 与入住重症监护病房、死亡或初始入院后 90 天内再入院的风险之间存在关联。
在因中度严重 CAP 住院的患者中，较短的抗生素给药时间与较好的结局无关。这些发现支持目前的建议，即不指定抗生素给药的特定时间框架。
