Takahashi Nozomi, Imaeda Taro, Nakada Taka-Aki, Oami Takehiko, Abe Toshikazu, Yamao Yasuo, Nakagawa Satoshi, Ogura Hiroshi, Shime Nobuaki, Matsushima Asako, Fushimi Kiyohide
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
J Intensive Care. 2022 Oct 29;10(1):49. doi: 10.1186/s40560-022-00642-3.
The appropriate duration of antibiotic treatment in patients with bacterial sepsis remains unclear. The purpose of this study was to evaluate the association of a shorter course of antibiotics on 28-day mortality in comparison with a longer course using a national database in Japan.
We conducted a post hoc analysis from the retrospective observational study of patients with sepsis using a Japanese claims database from 2010 to 2017. The patient dataset was divided into short-course (≤ 7 days) and long-course (≥ 8 days) groups according to the duration of initial antibiotic administration. Subsequently, propensity score matching was performed to adjust the baseline imbalance between the two groups. The primary outcome was 28-day mortality. The secondary outcomes were re-initiated antibiotics at 3 and 7 days, during hospitalization, administration period, antibiotic-free days, and medical cost.
After propensity score matching, 448,146 pairs were analyzed. The 28-day mortality was significantly lower in the short-course group (hazard ratio, 0.94; 95% CI, 0.92-0.95; P < 0.001), while the occurrence of re-initiated antibiotics at 3 and 7 days and during hospitalization were significantly higher in the short-course group (P < 0.001). Antibiotic-free days (median [IQR]) were significantly shorter in the long-course group (21 days [17 days, 23 days] vs. 17 days [14 days, 19 days], P < 0.001), and short-course administration contributed to a decrease in medical costs (coefficient $-212, 95% CI; - 223 to - 201, P < 0.001). Subgroup analyses showed a significant decrease in the 28-day mortality of the patients in the short-course group in patients of male sex (hazard ratio: 0.91, 95% CI; 0.89-0.93), community-onset sepsis (hazard ratio; 0.95, 95% CI; 0.93-0.98), abdominal infection (hazard ratio; 0.92, 95% CI; 0.88-0.97) and heart infection (hazard ratio; 0.74, 95% CI; 0.61-0.90), while a significant increase was observed in patients with non-community-onset sepsis (hazard ratio; 1.09, 95% CI; 1.06-1.12).
The 28-day mortality was significantly lower in the short-course group, even though there was a higher rate of re-initiated antibiotics in the short course.
细菌性脓毒症患者抗生素治疗的适宜疗程仍不明确。本研究旨在利用日本的全国数据库，评估较短疗程抗生素与较长疗程抗生素相比，对28天死亡率的影响。
我们对2010年至2017年使用日本索赔数据库的脓毒症患者回顾性观察研究进行了事后分析。根据初始抗生素给药疗程，将患者数据集分为短疗程（≤7天）和长疗程（≥8天）组。随后，进行倾向评分匹配以调整两组之间的基线不平衡。主要结局是28天死亡率。次要结局包括在第3天和第7天、住院期间重新开始使用抗生素、给药期、无抗生素天数和医疗费用。
倾向评分匹配后，分析了448,146对数据。短疗程组的28天死亡率显著较低（风险比，0.94；95%CI，0.92 - 0.95；P < 0.001），而短疗程组在第3天和第7天以及住院期间重新开始使用抗生素的发生率显著更高（P < 0.001）。长疗程组的无抗生素天数（中位数[四分位间距]）显著更短（21天[17天，23天]对17天[14天，19天]，P < 0.001），短疗程给药导致医疗费用降低（系数 - 212，95%CI； - 223至 - 201，P < 0.001）。亚组分析显示，短疗程组男性患者（风险比：0.91，95%CI；0.89 - 0.93）、社区获得性脓毒症患者（风险比；0.95，95%CI；0.93 - 0.98）、腹部感染患者（风险比；0.92，95%CI；0.88 - 0.97）和心脏感染患者（风险比；0.74，95%CI；0.61 - 0.90）的28天死亡率显著降低，而非社区获得性脓毒症患者（风险比；1.09，95%CI；1.06 - 1.12）的死亡率显著升高。
短疗程组的28天死亡率显著较低，尽管短疗程中重新开始使用抗生素的比例较高。
