抗生素选择对成人急性 COPD 加重后再入院的影响。
Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation.
机构信息
School of Pharmacy, Northeastern University, Boston, MA.
Department of Pharmacy, Lahey Hospital & Medical Center, Burlington, MA.
出版信息
Am J Health Syst Pharm. 2021 Feb 19;78(Suppl 1):S26-S32. doi: 10.1093/ajhp/zxaa317.
PURPOSE
The impact of antibiotic therapy in managing acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization remains unclear. We conducted a study to assess the impact of antibiotic therapy on the rate of 30-day readmission after discharge from a hospital stay for an acute COPD exacerbation. Additional study outcomes analyzed included the effects of antibiotic therapy on hospital length of stay, in-hospital mortality, 90-day and 12-month readmission rates, and time to next COPD exacerbation.
METHODS
The study was an institutional review board-approved, retrospective, observational review of adult patients at a tertiary academic medical center. The medical records of patients 18 years of age or older who were hospitalized for an acute COPD exacerbation between January 2008 and December 2014 were evaluated. Included patients were stratified by receipt of guideline-appropriate, guideline-inappropriate, or no antibiotic therapy. Nonparametric data were analyzed using the Kruskal-Wallis test (nonparametric) and categorical data via χ 2 test, respectively.
RESULTS
Three hundred twenty-five subjects were included; there were no significant differences in baseline characteristics in the 3 study groups. Sixty-eight percent of patients (n = 223) received antibiotics. The percentage of patients readmitted within 30 days did not differ between cohorts: 11.9% (appropriate therapy) vs 13.2% (nonappropriate therapy) vs 12.2% (no antibiotics) (P = 0.95 for all comparisons). Additionally, no detectable differences in 90-day or 12-month readmission rate, length of hospital day, or in-hospital mortality were found. However, a trend toward increased time to next COPD exacerbation was noted in those receiving antibiotics vs no antibiotics (352 days vs 192 days, P = 0.07).
CONCLUSION
Treatment of COPD exacerbations with antibiotics did not impact readmission rates, length of hospital stay, in-hospital mortality, or time to next exacerbation. More investigation is warranted to assess the effect of antibiotics on time to next exacerbation, as well as comparative effectiveness between antibiotic classes.
目的
抗生素治疗对需要住院治疗的急性慢性阻塞性肺疾病（COPD）加重的影响仍不清楚。我们进行了一项研究，以评估抗生素治疗对因急性 COPD 加重住院后 30 天再入院率的影响。分析的其他研究结果包括抗生素治疗对住院时间、住院死亡率、90 天和 12 个月再入院率以及下一次 COPD 加重时间的影响。
方法
这项研究是在一家三级学术医疗中心进行的机构审查委员会批准的回顾性观察研究。评估了 2008 年 1 月至 2014 年 12 月期间因急性 COPD 加重住院的 18 岁或以上患者的病历。纳入的患者按接受指南推荐的、指南不推荐的或不接受抗生素治疗进行分层。非参数数据采用 Kruskal-Wallis 检验（非参数），分类数据采用χ²检验。
结果
共纳入 325 例患者；三组患者的基线特征无显著差异。68%的患者（n=223）接受了抗生素治疗。在 30 天内再入院的患者比例在队列之间没有差异：11.9%（适当治疗）与 13.2%（非适当治疗）与 12.2%（无抗生素）（所有比较的 P=0.95）。此外，90 天和 12 个月的再入院率、住院天数或住院死亡率也没有差异。然而，与未接受抗生素治疗的患者相比，接受抗生素治疗的患者下一次 COPD 加重的时间有增加的趋势（352 天与 192 天，P=0.07）。
结论
抗生素治疗 COPD 加重不会影响再入院率、住院时间、住院死亡率或下一次加重时间。需要进一步研究评估抗生素对下一次加重时间的影响，以及抗生素类别之间的比较效果。
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