Dept Pulmonary Diseases, Northwest Hospital, Alkmaar, The Netherlands.
Dept of Pulmonary Diseases, Medic Spectrum Twente, Enschede, The Netherlands.
Eur Respir J. 2019 May 23;53(5). doi: 10.1183/13993003.02014-2018. Print 2019 May.
The role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD) is controversial and a biomarker identifying patients who benefit from antibiotics is mandatory. We performed a randomised, controlled trial in patients with acute exacerbations of COPD, comparing C-reactive protein (CRP)-guided antibiotic treatment to patient reported symptoms in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, in order to show a reduction in antibiotic prescription.Patients hospitalised with acute exacerbations of COPD were randomised to receive antibiotics based either on the GOLD strategy or according to the CRP strategy (CRP ≥50 mg·L).In total, 101 patients were randomised to the CRP group and 119 to the GOLD group. Fewer patients in the CRP group were treated with antibiotics compared to the GOLD group (31.7% 46.2%, p=0.028; adjusted odds ratio (OR) 0.178, 95% CI 0.077-0.411, p=0.029). The 30-day treatment failure rate was nearly equal (44.5% in the CRP group 45.5% in the GOLD-group, p=0.881; adjusted OR 1.146, 95% CI 0.649-1.187, p=0.630), as was the time to next exacerbation (32 days in the CRP group 28 days in the GOLD group, p=0.713; adjusted hazard ratio 0.878, 95% CI 0.649-1.187, p=0.398). Length of stay was similar in both groups (7 days in the CRP group 6 days in the GOLD group, p=0.206). On day-30, no difference in symptom score, quality of life or serious adverse events was detected.Use of CRP as a biomarker to guide antibiotic treatment in severe acute exacerbations of COPD leads to a significant reduction in antibiotic treatment. In the present study, no differences in adverse events between both groups were found. Further research is needed for the generalisability of these findings.
抗生素在慢性阻塞性肺疾病（COPD）急性加重期的作用存在争议，因此需要找到一种生物标志物来识别从抗生素治疗中获益的患者。我们在 COPD 急性加重患者中进行了一项随机对照试验，比较了 C 反应蛋白（CRP）指导的抗生素治疗与根据全球慢性阻塞性肺疾病倡议（GOLD）策略报告的患者症状，以显示抗生素处方的减少。因 COPD 急性加重而住院的患者被随机分为接受基于 GOLD 策略或 CRP 策略（CRP≥50mg·L）的抗生素治疗。共有 101 例患者被随机分配到 CRP 组，119 例患者被随机分配到 GOLD 组。与 GOLD 组相比，CRP 组接受抗生素治疗的患者更少（31.7%比 46.2%，p=0.028；调整后的优势比（OR）0.178，95%CI 0.077-0.411，p=0.029）。30 天治疗失败率几乎相等（CRP 组为 44.5%，GOLD 组为 45.5%，p=0.881；调整后的 OR 1.146，95%CI 0.649-1.187，p=0.630），下一次加重的时间也相同（CRP 组为 32 天，GOLD 组为 28 天，p=0.713；调整后的危险比 0.878，95%CI 0.649-1.187，p=0.398）。两组的住院时间相似（CRP 组为 7 天，GOLD 组为 6 天，p=0.206）。在第 30 天，两组的症状评分、生活质量或严重不良事件均无差异。使用 CRP 作为生物标志物指导严重 COPD 急性加重期的抗生素治疗可显著减少抗生素治疗。本研究中，两组间未发现不良事件的差异。需要进一步研究这些发现的普遍性。
