Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
J Infect Chemother. 2023 Jan;29(1):1-6. doi: 10.1016/j.jiac.2022.08.029. Epub 2022 Sep 8.
The optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown.
This was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan.
A total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early antibiotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52-0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63-0.84; p <0.001) and shorter length of stay (adjusted difference, -5.2 days; 95% confidence interval, -6.2 to -4.1 days; p <0.001) than those in the delayed antibiotics group.
Starting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay.
肝脓肿患者行肝穿刺或引流时，抗生素治疗的最佳时机尚不清楚。
这是一项回顾性队列研究，使用了日本全国性住院患者数据库——诊断程序组合数据库。
共纳入 2010 年 7 月至 2020 年 3 月期间因肝脓肿紧急住院的 34424 例患者。其中 31248 例（90.8%）在入院当天接受了抗生素治疗（早期抗生素组），3176 例（9.2%）未接受（延迟抗生素组）。多变量逻辑回归分析显示，早期抗生素组患者的院内死亡率明显低于延迟抗生素组（比值比，0.61；95%置信区间，0.52-0.72；p<0.001）。早期抗生素组患者临床恶化的比例明显较低（比值比，0.73；95%置信区间，0.63-0.84；p<0.001），住院时间也较短（调整差异，-5.2 天；95%置信区间，-6.2 至-4.1 天；p<0.001）。
入院当天开始抗生素治疗与死亡率降低、临床恶化比例降低和住院时间缩短相关。
