Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
BMC Emerg Med. 2021 Sep 27;21(1):108. doi: 10.1186/s12873-021-00505-4.
The selection of initial empirical antibiotics is an important issue in the treatment of severe community-acquired pneumonia (CAP). This study aimed to investigate whether empirical antibiotic prescription concordant with guidelines in the emergency department (ED) affects 30-day mortality in patients with severe CAP.
We conducted a retrospective analysis of adult patients with severe CAP who were hospitalized in the ED. Severe CAP was defined according to the criteria of the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines. Patients were divided into two groups according to whether they were prescribed empirical antibiotics concordant with guidelines. Multivariable Cox proportional hazard regression analysis was performed to identify the independent association between the prescription of initial empirical antibiotics concordant with the guidelines and 30-day mortality. Propensity score matching was performed to reduce selection bias between groups and Kaplan-Meier survival analysis was performed to analyze the time-to-event of 30-day survival.
In total, 630 patients were hospitalized in the ED for severe CAP, and 179 (28.4%) died within 30 days. Antibiotics consistent with guidelines were prescribed to 359 (57.0%) patients. The 30-day mortality was significantly higher in the guideline-discordant group (p = 0.003) and multivariable Cox proportional hazard regression analysis revealed that the prescription of antibiotics discordant with the guidelines was independently associated with 30-day mortality (hazard ratio 1.43, 95% CI 1.05-1.93). After propensity score matching, there were 255 patients in each group. The 30-day mortality was lower in the group prescribed guideline-concordant antibiotics than in the group prescribed guideline-discordant antibiotics (23.9% vs. 33.3%, p = 0.024). Kaplan-Meier survival analysis showed that antibiotic prescription concordant with the guidelines resulted in higher survival rates at 30 days (p = 0.002).
The prevalence of antibiotic prescription consistent with guidelines for severe CAP seemed to be low in the ED, and this variable was independently associated with 30-day survival.
初始经验性抗生素的选择是治疗严重社区获得性肺炎（CAP）的一个重要问题。本研究旨在探讨急诊科（ED）经验性抗生素治疗是否与指南一致是否会影响严重 CAP 患者的 30 天死亡率。
我们对在 ED 住院的成人严重 CAP 患者进行了回顾性分析。严重 CAP 根据 2007 年美国传染病学会/美国胸科学会指南的标准进行定义。根据是否使用与指南一致的经验性抗生素将患者分为两组。采用多变量 Cox 比例风险回归分析确定与指南一致的初始经验性抗生素治疗与 30 天死亡率之间的独立关联。采用倾向性评分匹配来减少组间选择偏倚，并采用 Kaplan-Meier 生存分析来分析 30 天生存的时间事件。
共有 630 例患者因严重 CAP 住院于 ED，其中 179 例（28.4%）在 30 天内死亡。359 例（57.0%）患者使用了与指南一致的抗生素。指南不一致组的 30 天死亡率明显更高（p=0.003），多变量 Cox 比例风险回归分析显示，与指南不一致的抗生素治疗与 30 天死亡率独立相关（危险比 1.43，95%CI 1.05-1.93）。进行倾向性评分匹配后，每组各有 255 例患者。使用与指南一致的抗生素治疗的患者的 30 天死亡率低于使用与指南不一致的抗生素治疗的患者（23.9% vs. 33.3%，p=0.024）。Kaplan-Meier 生存分析显示，与指南一致的抗生素治疗可在 30 天时提高生存率（p=0.002）。
ED 中严重 CAP 患者使用与指南一致的抗生素的比例似乎较低，该变量与 30 天生存率独立相关。
