Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
BMC Infect Dis. 2023 Sep 5;23(1):580. doi: 10.1186/s12879-023-08565-6.
Many factors determine empirical antibiotic treatment of community-acquired pneumonia (CAP). We aimed to describe the empirical antibiotic treatment CAP patients with an acute hospital visit and to determine if the current treatment algorithm provided specific and sufficient coverage against Legionella pneumophila, Mycoplasma pneumoniae, and Clamydophila pneumoniae (LMC).
A descriptive cross-sectional, multicenter study of all adults with an acute hospital visit in the Region of Southern Denmark between January 2016 and March 2018 was performed. Using medical records, we retrospectively identified the empirical antibiotic treatment and the microbiological etiology for CAP patients. CAP patients who were prescribed antibiotics within 24 h of admission and with an identified bacterial pathogen were included. The prescribed empirical antibiotic treatment and its ability to provide specific and sufficient coverage against LMC pneumonia were determined.
Of the 19,133 patients diagnosed with CAP, 1590 (8.3%) patients were included in this study. Piperacillin-tazobactam and Beta-lactamase sensitive penicillins were the most commonly prescribed empirical treatments, 515 (32%) and 388 (24%), respectively. Our analysis showed that 42 (37%, 95% CI: 28-47%) of 113 patients with LMC pneumonia were prescribed antibiotics with LMC coverage, and 42 (12%, 95% CI: 8-15%) of 364 patients prescribed antibiotics with LMC coverage had LMC pneumonia.
Piperacillin-tazobactam, a broad-spectrum antibiotic recommended for uncertain infectious focus, was the most frequent CAP treatment and prescribed to every third patient. In addition, the current empirical antibiotic treatment accuracy was low for LMC pneumonia. Therefore, future research should focus on faster diagnostic tools for identifying the infection focus and precise microbiological testing.
许多因素决定了社区获得性肺炎（CAP）的经验性抗生素治疗。我们旨在描述急性住院就诊的 CAP 患者的经验性抗生素治疗，并确定当前的治疗方案是否对嗜肺军团菌、肺炎支原体和肺炎衣原体（LMC）提供了具体和充分的覆盖。
这是一项在 2016 年 1 月至 2018 年 3 月期间在丹麦南部地区进行的描述性、横断面、多中心研究。我们使用病历回顾性地确定了 CAP 患者的经验性抗生素治疗和微生物病因。纳入在入院 24 小时内开出处方抗生素且有明确细菌病原体的 CAP 患者。确定了所开处方的经验性抗生素治疗及其对 LMC 肺炎提供具体和充分覆盖的能力。
在诊断为 CAP 的 19133 例患者中，有 1590 例（8.3%）患者纳入本研究。哌拉西林他唑巴坦和β-内酰胺酶敏感青霉素是最常开的经验性治疗药物，分别为 515 例（32%）和 388 例（24%）。我们的分析显示，113 例 LMC 肺炎患者中有 42 例（37%，95%CI：28-47%）开了有 LMC 覆盖的抗生素，而 364 例开了有 LMC 覆盖的抗生素的患者中有 42 例（12%，95%CI：8-15%）患有 LMC 肺炎。
哌拉西林他唑巴坦是一种广谱抗生素，推荐用于不确定的感染焦点，是最常见的 CAP 治疗药物，每三个患者中就有一个开了这种药。此外，目前 LMC 肺炎的经验性抗生素治疗准确性较低。因此，未来的研究应侧重于更快的诊断工具，以确定感染焦点和精确的微生物检测。
