Mponponsuo Kwadwo, Pinto Ruxandra, Fowler Robert, Rogers Ben, Daneman Nick
Sunnybrook Research Institute, Toronto, Canada.
Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, Canada.
JAC Antimicrob Resist. 2023 Aug 1;5(4):dlad087. doi: 10.1093/jacamr/dlad087. eCollection 2023 Aug.
Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates.
We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations.
Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI.
There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.
传统上，细菌感染采用固定疗程的抗生素治疗；然而，一些人主张采用个体化疗程。目前尚不清楚哪种方法占主导地位。
我们进行了一项跨国临床实践调查，询问处方医生治疗皮肤和软组织感染（SSTI）、社区获得性肺炎（CAP）、肾盂肾炎、胆管炎和不明来源血流感染（BSI）的方法。主要结果是自我报告的治疗方法，即完全固定疗程、固定最短疗程、固定最长疗程、固定最短和最长疗程或完全个体化疗程。次要问题探讨了影响治疗疗程的因素。使用广义估计方程的多变量逻辑回归用于检验使用完全固定疗程的预测因素。
在221名受访者中，170名（76.9%）完成了完整调查；传染病医生占60.6%。完全固定疗程在SSTI中使用最少（8.5%），在CAP中更常见（28.3%），在BSI中（29.9%）、胆管炎中（35.7%）和肾盂肾炎中（36.3%）。完全个体化治疗，即没有固定的最短或最长疗程，仅被少数人使用：CAP（4.9%）、肾盂肾炎（5.0%）、胆管炎（9.9%）、BSI（13.6%）和SSTI（19.5%）。在多变量分析中，完全固定疗程的方法在加拿大受访者中更常见[调整后的比值比（aOR）为1.76（95%置信区间1.12-2.76）]，在CAP（aOR 4.25，95%置信区间2.53-7.13）、胆管炎（aOR 6.01，95%置信区间3.49-10.36）、肾盂肾炎（aOR 6.08，95%置信区间3.56-10.39）和BSI（aOR 4.49，95%置信区间2.50-8.09）中与SSTI相比更常见。
在固定治疗与个体化治疗方面存在广泛的实践异质性；临床试验有助于比较这些方法。
