Paprocki Marcin, Żwirowski Szymon, Kuziemski Krzysztof
Private Health Care Facility, Outpatient Clinic Suchanino, Otwarta 4, 80-169, Gdańsk, Poland.
AstraZeneca Pharma Poland, Postępu 14, Warszawa, Poland.
Sci Rep. 2025 Jan 15;15(1):1969. doi: 10.1038/s41598-025-85388-2.
Chronic obstructive pulmonary disease (COPD) exacerbations frequently cause patient consultations in both out- and inpatient settings. Recent data suggest that only 40-60% of exacerbations are of bacterial origin and mandate antibiotic treatment. However, a reliable tool to justify prescribing antibiotics for COPD exacerbation is still lacking. This study was designed to explore the hypothesis that utilization of a novel decision-making tool called Prospector would lead to lower consumption of antibiotics and provide a more rational approach to managing COPD exacerbations versus standard therapy in patients with COPD. The study included 77 COPD patients who experienced a COPD exacerbation and were treated in outpatient settings. The Prospector group (PG) (n = 40) were treated by the study author using the Prospector calculator (a tool designed by the first author that translates: patient symptoms, exacerbation, and medical history of COPD into a decision on the use of antibiotics in COPD exacerbation treatment). Other primary care specialists treated the control group (CG) (n = 37) in the same outpatient clinic; antibiotic therapies were implemented at the physician's discretion, most often using Anthonisen's criteria. All other medications were administered at the physician's discretion. Safety endpoints were set as: death, hospitalization, and number of exacerbations. Antibiotics were administered in 32.8% and 81.2% of exacerbations in the PG and CG, respectively (p < 0.0001). A comparable percentage was verified positively in both PG patient subsets: those that did and did not receive antibiotics at visit 1 (94.7% and 94.9%, respectively). Twenty-eight patients in the PG and 37 in the CG were followed for up to 35 months. Failure to recover (defined as deterioration or lack of improvement) in 30 days following exacerbation was 10.7% in the PG and 47.2% in the CG. In the CG, the failure rate was significantly higher (p = 0.0043). Hospitalization rates in the PG and the CG were 42.9% and 94.4%, respectively. In the CG, the hospitalization rate was significantly higher (p < 0.0001). COPD hospitalization rates in the PG and the CG were 17.9% and 33.3%, respectively (p = 0.1643). This preliminary study suggests that using the Prospector calculator results in markedly reduced antibiotic prescription for COPD exacerbations. No new safety signals have been identified for the method.
慢性阻塞性肺疾病（COPD）急性加重经常导致患者在门诊和住院环境中就诊。最近的数据表明，只有40%-60%的急性加重是由细菌引起的，需要使用抗生素治疗。然而，目前仍缺乏一种可靠的工具来证明为COPD急性加重开具抗生素是合理的。本研究旨在探讨一种名为“探矿者”的新型决策工具的应用是否会导致抗生素使用量降低，并为COPD急性加重的管理提供一种比标准治疗更合理的方法。该研究纳入了77例经历COPD急性加重并在门诊接受治疗的COPD患者。“探矿者”组（PG）（n = 40）由研究作者使用“探矿者”计算器进行治疗（该工具由第一作者设计，可将患者症状、急性加重情况和COPD病史转化为COPD急性加重治疗中使用抗生素的决策）。其他初级保健专家在同一门诊治疗对照组（CG）（n = 37）；抗生素治疗由医生自行决定，最常用的是安东尼森标准。所有其他药物均由医生自行决定使用。设定的安全终点为：死亡、住院和急性加重次数。PG组和CG组急性加重时使用抗生素的比例分别为32.8%和81.2%（p < 0.0001）。在PG组的两个亚组中，即就诊1时接受和未接受抗生素治疗的患者中，得到了类似的阳性比例（分别为94.7%和94.9%）。PG组的28例患者和CG组的37例患者随访了长达35个月。急性加重后30天内未恢复（定义为病情恶化或无改善）的比例在PG组为10.7%，在CG组为47.2%。在CG组中，失败率显著更高（p = 0.0043）。PG组和CG组的住院率分别为42.9%和94.4%。在CG组中，住院率显著更高（p < 0.0001）。PG组和CG组的COPD住院率分别为17.9%和33.3%（p = 0.1643）。这项初步研究表明，使用“探矿者”计算器可显著减少COPD急性加重时的抗生素处方。该方法未发现新的安全信号。
