Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.
Research Unit, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain.
BMC Pulm Med. 2020 Oct 7;20(1):261. doi: 10.1186/s12890-020-01293-6.
The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP.
This was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30.
A total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52).
Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.
社区获得性肺炎（CAP）的最佳抗生素治疗持续时间尚未确定。本研究旨在评估缩短抗生素治疗时间对 CAP 住院患者长期预后的影响。
这是一项多中心研究，评估了先前纳入抗生素治疗持续时间随机临床试验的 CAP 住院患者在 1 年内发生的并发症。分析了 90 天、180 天和 1 年的死亡率，以及新入院和心血管并发症。在其中一家医院进行了亚分析，测量了入院时、第 5 天和第 30 天的 C 反应蛋白（CRP）、降钙素原（PCT）和前肾上腺髓质素（proADM）。
共纳入 312 例患者，对照组 150 例，干预组 162 例。意向治疗分析中，90 天、180 天和 1 年的死亡率分别为 8（2.57%）、10（3.22%）和 14（4.50%）。两组在 1 年死亡率（p=0.94）、新入院率（p=0.84）或心血管事件发生率（p=0.33）方面无显著差异。从第 5 天到第 30 天，生物标志物水平差异无统计学意义（CRP p=0.29；PCT p=0.44；proADM p=0.52）。
基于临床稳定标准，缩短 CAP 住院患者的抗生素治疗是安全的，不会导致更多的长期并发症。
