Caffrey Aisling R, Appaneal Haley J, Liao J Xin, Piehl Emily C, Lopes Vrishali, Puzniak Laura A
Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI 02908, USA.
Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI 02908, USA.
Antibiotics (Basel). 2022 Jul 30;11(8):1033. doi: 10.3390/antibiotics11081033.
We have previously identified substantial antibiotic treatment heterogeneity, even among organism-specific and site-specific infections with treatment guidelines. Therefore, we sought to quantify the extent of treatment heterogeneity among patients hospitalized with pneumonia in the national Veterans Affairs Healthcare System from Jan-2015 to Apr-2018. Daily antibiotic exposures were mapped from three days prior to culture collection until discharge. Heterogeneity was defined as unique patterns of antibiotic treatment (drug and duration) not shared by any other patient. Our study included 5300 patients, of whom 87.5% had unique patterns of antibiotic drug and duration. Among patients receiving any initial antibiotic/s with a change to at least one anti-pseudomonal antibiotic (n = 3530, 66.6%) heterogeneity was 97.2%, while heterogeneity was 91.5% in those changing from any initial antibiotic/s to only anti-pseudomonal antibiotics (n = 576, 10.9%). When assessing heterogeneity of anti-pseudomonal antibiotic classes, irrespective of other antibiotic/s received (n = 4542, 85.7%), 50.5% had unique patterns of antibiotic class and duration, with median time to first change of three days, and a median of two changes. Real-world evidence is needed to inform the development of treatment pathways and antibiotic stewardship initiatives based on clinical outcome data, which is currently lacking in the presence of such treatment heterogeneity.
我们之前已经发现，即使在有治疗指南的特定病原体和特定部位感染中，抗生素治疗也存在很大差异。因此，我们试图量化2015年1月至2018年4月期间在国家退伍军人事务医疗系统中因肺炎住院的患者之间治疗差异的程度。从培养物采集前三天到出院，记录每日抗生素暴露情况。差异被定义为任何其他患者都没有的独特抗生素治疗模式（药物和疗程）。我们的研究纳入了5300名患者，其中87.5%的患者有独特的抗生素药物和疗程模式。在接受任何初始抗生素并至少更换为一种抗假单胞菌抗生素的患者中（n = 3530，66.6%），差异为97.2%，而从任何初始抗生素仅更换为抗假单胞菌抗生素的患者中（n = 576，10.9%），差异为91.5%。在评估抗假单胞菌抗生素类别的差异时，无论接受其他何种抗生素（n = 4542，85.7%），50.5%的患者有独特的抗生素类别和疗程模式，首次更换的中位时间为三天，中位更换次数为两次。需要真实世界的证据来为基于临床结局数据的治疗路径和抗生素管理举措的制定提供信息，而目前在存在这种治疗差异的情况下缺乏此类数据。
