Alyacoubi Said, Abuowda Yousef, Albarqouni Loai, Böttcher Bettina, Elessi Khamis
Nuffield Department of Surgical Sciences, Medical Sciences Divisions, University of Oxford, Oxford, UK.
Faculty of Medicine, Islamic University of Gaza, Gaza Strip, occupied Palestinian territory.
Lancet. 2018 Feb 21;391 Suppl 2:S40. doi: 10.1016/S0140-6736(18)30406-9.
Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence.
Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively. Clinical practice was compared with recommendations for severity assessment and the management of community-acquired pneumonia, as reported in guidelines by the National Institute for Health and Care Excellence and the American Thoracic Society. Ethical approval was obtained from the General Directorate of Human Resources.
141 patients were admitted to the European Gaza Hospital with community-acquired pneumonia during the study period. Records of 41 patients were missing or could not be retrieved. The mean age of patients was 55·9 years (SD 20·2). Blood urea and nitrogen concentrations were not documented for 48 (48%) patients, and respiratory rate was not documented for 73 (73%) patients. The CURB-65 score was determined only for 12 (12%) patients. Microbiological testing was done only for two (2%) patients. Although 18 different antibiotic regimens were used, 81 (81%) patients received a β-lactam plus macrolide combination therapy, either given alone (49 [49%] patients) or with another antibiotic (32 [32%] patients), which is in line with the recommendations for patients admitted to hospital with community-acquired pneumonia. 43 (43%) patients received anti-viral drugs, and 41 (41%) patients received corticosteroids.
Clinicians were poorly adherent to current standards of care in severity assessment and management of community-acquired pneumonia. Moreover, the broad range of antibiotic regimes used, without microbiological guidance, was inappropriate and will have increased the risk of antibiotic resistance. A local evidence-based clinical practice guideline should be developed and implemented. Furthermore, the documentation system should be improved to enhance the continuity of care and clinical auditing.
None.
疾病严重程度评分，如CURB - 65，常被用于指导社区获得性肺炎患者的管理。早期且充分的经验性抗生素治疗可降低死亡率。本研究的目的是调查加沙地带欧洲加沙医院社区获得性肺炎患者的严重程度评估及管理情况，并将其与现有最佳证据进行比较。
回顾性分析2015年12月1日至2016年3月31日期间入住欧洲加沙医院且诊断为社区获得性肺炎的所有患者的病历。将临床实践与英国国家卫生与临床优化研究所及美国胸科学会指南中关于社区获得性肺炎严重程度评估及管理的建议进行比较。已获得人力资源总局的伦理批准。
在研究期间，141例患者因社区获得性肺炎入住欧洲加沙医院。41例患者的病历缺失或无法获取。患者的平均年龄为55.9岁（标准差20.2）。48例（48%）患者未记录血尿素和氮浓度，73例（73%）患者未记录呼吸频率。仅12例（12%）患者确定了CURB - 65评分。仅2例（2%）患者进行了微生物检测。尽管使用了18种不同的抗生素治疗方案，但81例（81%）患者接受了β - 内酰胺类加大环内酯类联合治疗，单独使用（49例[49%]患者）或与另一种抗生素联合使用（32例[32%]患者），这与社区获得性肺炎住院患者的治疗建议一致。43例（43%）患者接受了抗病毒药物治疗，41例（41%）患者接受了皮质类固醇治疗。
临床医生在社区获得性肺炎严重程度评估及管理方面对当前护理标准的依从性较差。此外，在没有微生物学指导的情况下使用的广泛抗生素治疗方案是不恰当的，这会增加抗生素耐药性的风险。应制定并实施基于当地证据的临床实践指南。此外，应改进文档系统以加强护理连续性和临床审计。
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