第三代头孢菌素是否比阿莫西林-克拉维酸在因社区获得性肺炎住院的内科患者中的预后更好？

Are third-generation cephalosporins associated with a better prognosis than amoxicillin-clavulanate in patients hospitalized in the medical ward for community-onset pneumonia?

机构信息

Université de Nantes, Microbiotas Hosts Antibiotics Bacterial Resistances (MiHAR), Institut de Recherche en Santé 2, Nantes, France; CHU Nantes, Emergency Department, Nantes, France.

出版信息

Clin Microbiol Infect. 2018 Nov;24(11):1171-1176. doi: 10.1016/j.cmi.2018.06.021. Epub 2018 Jun 28.

DOI:10.1016/j.cmi.2018.06.021

PMID:29964229

Abstract

OBJECTIVES

We aimed to assess whether treatment with ceftriaxone/cefotaxime is associated with lower in-hospital mortality than amoxicillin-clavulanate in pati0ents hospitalized in medical wards for community-onset pneumonia.

METHODS

We conducted a retrospective and multicentre study of patients hospitalized in French medical wards for community-onset pneumonia between 2002 and 2015. Treatments with ceftriaxone/cefotaxime or amoxicillin-clavulanate were defined by their start in the emergency department for a duration of 5 days or more with no other β-lactam. A logistic regression analysis was performed on the overall population, and a propensity score analysis was restricted to patients treated with either ceftriaxone/cefotaxime or amoxicillin-clavulanate.

RESULTS

1698 patients (median age, 80 y) were included, of which 716 and 198 were treated with amoxicillin-clavulanate and ceftriaxone/cefotaxime, respectively. In-hospital mortality was 10% (9-12%). In multivariate analysis, factors associated with in-hospital mortality were treatment with ceftriaxone/cefotaxime (aOR 2.9; (1.4-5.7)), pneumonia severity index class 4 or 5 (aOR 7.8 (4.3-15.7)), do-not-resuscitate order (aOR 8.7 (5.2-14.6)) and fluid therapy (aOR 6.3 (2.5-15.1)). The propensity score analysis was performed on 178 patients treated with ceftriaxone/cefotaxime matched with 178 patients treated with amoxicillin-clavulanate; no significant association between treatment with ceftriaxone/cefotaxime and in-hospital mortality was found (OR 1.5 (0.7-3.0)).

CONCLUSION

In the largest study aiming to compare amoxicillin-clavulanate and ceftriaxone/cefotaxime in community-onset pneumonia, ceftriaxone/cefotaxime was not associated with lower in-hospital mortality than amoxicillin-clavulanate. Our results suggest that ceftriaxone/cefotaxime should not be preferred over amoxicillin-clavulanate for patients hospitalized in medical wards with community-onset pneumonia.

摘要

目的

我们旨在评估头孢曲松/头孢噻肟治疗与阿莫西林克拉维酸治疗相比，是否与社区获得性肺炎住院患者的院内死亡率降低相关。

方法

我们进行了一项回顾性多中心研究，纳入了 2002 年至 2015 年期间在法国内科病房因社区获得性肺炎住院的患者。头孢曲松/头孢噻肟或阿莫西林克拉维酸的治疗定义为在急诊科开始治疗，持续 5 天或以上，且未使用其他β-内酰胺类药物。对总体人群进行了逻辑回归分析，并对接受头孢曲松/头孢噻肟或阿莫西林克拉维酸治疗的患者进行了倾向评分分析。

结果

共纳入 1698 例患者（中位年龄 80 岁），其中 716 例和 198 例分别接受了阿莫西林克拉维酸和头孢曲松/头孢噻肟治疗。院内死亡率为 10%（9-12%）。多变量分析显示，与院内死亡率相关的因素包括使用头孢曲松/头孢噻肟（优势比 2.9；1.4-5.7）、肺炎严重指数 4 或 5 级（优势比 7.8（4.3-15.7））、不复苏医嘱（优势比 8.7（5.2-14.6））和液体治疗（优势比 6.3（2.5-15.1））。对 178 例接受头孢曲松/头孢噻肟治疗的患者进行了倾向评分分析，并与 178 例接受阿莫西林克拉维酸治疗的患者进行了匹配；未发现头孢曲松/头孢噻肟治疗与院内死亡率之间存在显著关联（比值比 1.5（0.7-3.0））。