Department of General Internal Medicine and Infectious Disease, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Sapporo Shi Teine Ku, Hokkaido, 006-0811, Japan.
Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.
Intern Emerg Med. 2021 Oct;16(7):1841-1848. doi: 10.1007/s11739-021-02695-y. Epub 2021 Mar 13.
Patients with aspiration pneumonitis often receive empiric antibiotic therapy despite it being due to a non-infectious, inflammatory response.
To study the benefits of early antibiotic therapy in patients with suspected aspiration pneumonitis in an acute care hospital.
Retrospective cohort study using electronic medical records from Teine Keijinkai Hospital.
Adults aged over 18 years admitted with a diagnosis of aspiration pneumonitis to the Department of General Internal Medicine or Emergency Department between January 1, 2008, and May 31, 2019. A diagnosis of aspiration pneumonitis was defined as a documented macro-aspiration event and a chest radiograph demonstrating new radiographic infiltrates.
Patients were classified into the "early antibiotic treatment" group and the "no or late treatment" group depending on whether they received antibiotic therapy for respiratory bacterial pathogens within 8 h of arrival. The primary outcome was in-hospital all-cause mortality. Secondary outcomes included length of hospital stay, antibiotic-free days, duration of fever, readmission within one month, and incidence of complications.
Of the 146 patients enrolled, 52 (35.6%) did not receive early antibiotic therapy, while the remaining 94 (64.4%) did. There was no difference in in-hospital mortality rates between the groups after adjustment for potential confounding variables using Cox proportional hazards analysis (hazard ratio 2.78; 95% confidence interval, 0.57-13.50, p = 0.20). Patients in the no or late treatment group had more antibiotic-free days (p < 0.001) and a shorter length of hospital stay among survivors (p = 0.040) than did those in the early antibiotic treatment group. There were no statistically significant differences between the groups with respect to other secondary outcomes.
Early antibiotic therapy for acute aspiration pneumonitis was not associated with in-hospital mortality, but was associated with a longer hospital stay and prolonged use of antibiotics.
尽管患有吸入性肺炎的患者通常是由于非感染性炎症反应引起的，但他们仍经常接受经验性抗生素治疗。
研究在急性护理医院中，疑似吸入性肺炎患者接受早期抗生素治疗的益处。
使用来自天神会医院的电子病历进行回顾性队列研究。
2008 年 1 月 1 日至 2019 年 5 月 31 日期间，因吸入性肺炎被收入内科或急诊科的年龄超过 18 岁的成年人。吸入性肺炎的诊断标准为有记录的大口吸入事件和胸部 X 光片显示新的放射性浸润。
根据患者到达后 8 小时内是否接受针对呼吸细菌病原体的抗生素治疗，将患者分为“早期抗生素治疗”组和“无或晚期治疗”组。主要结局是院内全因死亡率。次要结局包括住院时间、无抗生素天数、发热持续时间、一个月内再入院率和并发症发生率。
在纳入的 146 名患者中，52 名（35.6%）未接受早期抗生素治疗，而其余 94 名（64.4%）接受了治疗。在调整潜在混杂因素后，使用 Cox 比例风险分析，两组之间的院内死亡率无差异（风险比 2.78；95%置信区间，0.57-13.50，p=0.20）。与早期抗生素治疗组相比，无或晚期治疗组的存活患者的无抗生素天数更多（p<0.001），住院时间更短（p=0.040）。两组在其他次要结局方面无统计学差异。
急性吸入性肺炎的早期抗生素治疗与院内死亡率无关，但与住院时间延长和抗生素使用时间延长有关。
