Tomczyk Sara, Jain Seema, Bramley Anna M, Self Wesley H, Anderson Evan J, Trabue Chris, Courtney D Mark, Grijalva Carlos G, Waterer Grant W, Edwards Kathryn M, Wunderink Richard G, Hicks Lauri A
Epidemic Intelligence Service.
Respiratory Diseases Branch.
Open Forum Infect Dis. 2017 Jun 20;4(2):ofx088. doi: 10.1093/ofid/ofx088. eCollection 2017 Spring.
Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP.
From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression.
Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics.
Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.
美国传染病学会（IDSA）/美国胸科学会（ATS）2007年社区获得性肺炎（CAP）指南推荐，对于因CAP住院的成人患者，呼吸喹诺酮类药物或β-内酰胺类药物加用大环内酯类药物作为一线抗生素。很少有研究评估2007年IDSA/ATS指南发布后因CAP住院患者遵循指南使用抗生素的情况。我们研究了因CAP住院成人患者的抗生素处方及相关因素。
2010年1月至2012年6月，因临床及影像学确诊为CAP住院的成人患者纳入一项在美国5家医院开展的社区肺炎病因前瞻性研究。使用标准化问卷对患者进行访谈，并查阅病历。根据定义的不推荐用于CAP的抗生素对所开具的抗生素进行分类。我们采用逻辑回归分析评估与不推荐用于CAP的抗生素相关的因素。
在纳入的患者中，1874名病房患者中的1843名（98%）以及446名重症监护病房（ICU）患者中的440名（99%）在入院后≤24小时接受了≥1种抗生素治疗。病房患者在入院后≤24小时单独使用呼吸喹诺酮类药物（n = 613；33%），或β-内酰胺类药物加用大环内酯类药物（n = 365；19%）、单独使用β-内酰胺类药物（n = 240；13%），以及使用其他抗生素，包括万古霉素（n = 235；13%）或哌拉西林/他唑巴坦（n = 157；8%）。已知有医疗保健相关肺炎（HCAP）风险、近期门诊使用过抗生素以及入院后<6小时内使用过医院内抗生素的病房患者更有可能接受不推荐用于CAP的抗生素。
尽管超过一半的病房患者接受了符合IDSA/ATS指南的抗生素治疗，但仍有一些患者接受了不推荐用于CAP的抗生素，包括万古霉素和哌拉西林/他唑巴坦；HCAP风险因素、近期门诊抗生素使用以及住院后迅速使用抗生素促成了这种情况。这项产生假设的描述性流行病学分析有助于为抗生素管理工作提供信息，强化了统一CAP和HCAP指南的必要性，并突出了改进诊断方法以更好地武装临床医生的必要性。
