β-内酰胺类和大环内酯类联合治疗在重症监护病房住院的社区获得性肺炎患者中的作用：一项前瞻性队列研究的倾向评分分析。
Usefulness of β-lactam and macrolide combination therapy for treating community-acquired pneumonia patients hospitalized in the intensive care unit: Propensity score analysis of a prospective cohort study.
机构信息
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, 11 Nakaashihara, Joyo, Kyoto 610-0113, Japan.
出版信息
J Infect Chemother. 2021 Oct;27(10):1447-1453. doi: 10.1016/j.jiac.2021.06.003. Epub 2021 Jun 17.
INTRODUCTION
Whether β-lactam and macrolide combination therapy reduces mortality in severe community-acquired pneumonia (SCAP) patients hospitalized in the intensive care unit (ICU) is controversial. The aim of the present study was to evaluate the usefulness of β-lactam and macrolide combination therapy for SCAP patients hospitalized in the ICU.
METHODS
A prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized SCAP patients admitted to the ICU within 24 h between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting (IPTW) analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score.
RESULTS
A total of 78 patients were included, with 48 patients in the non-macrolide-containing β-lactam therapy group and 30 patients in the macrolide combination therapy group. β-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P = 0.015) and 14-day mortality (6.7% vs. 31.3%; P = 0.020), but not ICU mortality (10% vs 27.1%, P = 0.08) compared with non-macrolide-containing β-lactam therapy. After adjusting by IPTW, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09-0.96; P = 0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04-0.92; P = 0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08-1.36; P = 0.13).
CONCLUSIONS
Combination therapy with β-lactam and macrolides significantly improved the prognosis of SCAP patients hospitalized in the ICU compared with a non-macrolide-containing β-lactam regimen.
简介
在重症监护病房（ICU）住院的严重社区获得性肺炎（SCAP）患者中，β-内酰胺和大环内酯类联合治疗是否降低死亡率存在争议。本研究旨在评估β-内酰胺和大环内酯类联合治疗对 ICU 住院 SCAP 患者的疗效。
方法
进行了一项前瞻性、观察性、队列研究，纳入了 2010 年 10 月至 2017 年 10 月期间入住 ICU 的住院肺炎患者。对入住 ICU 24 小时内确诊为 SCAP 的患者进行分析。主要结局为 30 天死亡率，次要结局为 14 天死亡率和 ICU 死亡率。采用逆概率治疗加权（IPTW）分析作为倾向评分分析，以减少包括年龄、性别、C 反应蛋白、白蛋白、肺炎严重指数评分和急性生理学与慢性健康状况评分 II （APACHE II）评分在内的 6 个协变量的偏倚。
结果
共纳入 78 例患者，其中非大环内酯类β-内酰胺治疗组 48 例，大环内酯类联合治疗组 30 例。与非大环内酯类β-内酰胺治疗组相比，β-内酰胺和大环内酯类联合治疗组显著降低了 30 天死亡率（16.7% vs. 43.8%；P=0.015）和 14 天死亡率（6.7% vs. 31.3%；P=0.020），但对 ICU 死亡率（10% vs. 27.1%；P=0.08）无显著影响。经 IPTW 校正后，联合治疗组 30 天死亡率（比值比，0.29；95%置信区间，0.09-0.96；P=0.04）和 14 天死亡率（比值比，0.19；95%置信区间，0.04-0.92；P=0.04）也显著降低，但 ICU 死亡率（比值比，0.34；95%置信区间，0.08-1.36；P=0.13）无显著变化。
结论
与非大环内酯类β-内酰胺方案相比，β-内酰胺和大环内酯类联合治疗可显著改善 ICU 住院 SCAP 患者的预后。
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