Lodise Thomas P, Van Le Hoa, LaPensee Kenneth
Albany College of Pharmacy and Health Sciences 106 New Scotland Ave, Albany, NY 12208-3492, USA.
PAREXEL International 2520 Meridian Parkway, Suite 200, Durham, NC 27713, USA.
Antibiotics (Basel). 2020 Sep 4;9(9):577. doi: 10.3390/antibiotics9090577.
(1) Objective: There are limited data regarding community-acquired pneumonia (CAP) admissions patterns in US hospitals. Current expert CAP guidelines advocate for outpatient treatment or an abbreviated hospital stay for CAP patients in pneumonia severity index (PSI) risk classes I-III (low risk); however, the extent of compliance with this recommendation is unclear. This study sought to estimate the proportion of admissions among CAP patients who received ceftriaxone and macrolide therapy, one of the most commonly prescribed guideline-concordant CAP regimens, by PSI risk class and Charlson comorbidity index (CCI) score. (2) Methods: A retrospective cross-sectional study of patients in the Vizient (MedAssets, Irving, Texas) database between 2012 and 2015 was performed. Patients were included if they were aged ≥ 18 years, had a primary diagnosis for CAP, and received ceftriaxone and a macrolide on hospital day 1 or 2. Baseline demographics and admitting diagnoses were used to calculate the PSI score. Patients in the final study population were grouped into categories by their PSI risk class and CCI score. Hospital length of stay, 30-day mortality rates, and 30-day CAP-related readmissions were calculated across resulting PSI-CCI strata. (3) Results: Overall, 32,917 patients met the study criteria. Approximately 70% patients were in PSI risk classes I-III and length of stay ranged between 4.9 and 6.2 days, based on CCI score. The 30-day mortality rate was <0.5% and <1.4% in patients with PSI risk classes I and II, respectively. (4) Conclusions: Over two-thirds of hospitalized patients with CAP who received ceftriaxone and a macrolide were in PSI risk classes I-III. Although the findings should be interpreted with caution, they suggest that there is a potential opportunity to improve the efficiency of healthcare delivery for CAP patients by shifting inpatient care to the outpatient setting in appropriate patients.
(1) 目的：关于美国医院社区获得性肺炎（CAP）的入院模式的数据有限。当前的专家CAP指南提倡对肺炎严重程度指数（PSI）风险等级为I - III级（低风险）的CAP患者进行门诊治疗或缩短住院时间；然而，这一建议的遵循程度尚不清楚。本研究旨在按PSI风险等级和查尔森合并症指数（CCI）评分估算接受头孢曲松和大环内酯类药物治疗（最常用的符合指南的CAP治疗方案之一）的CAP患者的入院比例。(2) 方法：对2012年至2015年Vizient（MedAssets，得克萨斯州欧文）数据库中的患者进行回顾性横断面研究。纳入年龄≥18岁、主要诊断为CAP且在住院第1天或第2天接受头孢曲松和大环内酯类药物治疗的患者。使用基线人口统计学数据和入院诊断来计算PSI评分。最终研究人群中的患者按其PSI风险等级和CCI评分进行分组。计算各PSI - CCI分层的住院时间、30天死亡率和30天CAP相关再入院率。(3) 结果：总体而言，32917名患者符合研究标准。根据CCI评分，约70%的患者处于PSI风险等级I - III级，住院时间在4.9至6.2天之间。PSI风险等级为I级和II级的患者30天死亡率分别<0.5%和<1.4%。(4) 结论：接受头孢曲松和大环内酯类药物治疗的住院CAP患者中，超过三分之二处于PSI风险等级I - III级。尽管这些发现应谨慎解读，但它们表明通过将适当患者的住院治疗转移到门诊环境，有可能提高CAP患者的医疗服务效率。
