Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia
Timing of antibiotic administration and outcomes for medicare patients hospitalized with community-acquired pneumonia
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DOI：
10.1001/archinte.164.6.637
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发表时间：
2004-03-22
影响因子：
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通讯作者：
Bartlett, JG
中科院分区：
文献类型：
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作者：
Houck, PM;Bratzler, DW;Bartlett, JG
背景：肺炎每年导致60多万人因肺炎而住院。指南建议在到达医院的8小时内进行抗生素治疗。方法：我们对1998年7月至1999年3月期间因社区获得性肺炎住院的18209名65岁以上的老年医疗保险患者的病历进行了回顾性研究。结果：在13771名(75.6%)没有接受门诊抗生素治疗的患者中，在到达医院后4小时内使用抗生素降低了住院死亡率(6.8%比7.4%；调整后的优势比[AOR]，0.85；95%的可信区间[CI]，0.74-0.98)，入院30天内的死亡率(11.6%比12.7%；AOR，0.85；95%CI，0.76~0.95)，LOS超过5天中位数(42.1%vs 45.1%；AOR，0.90；95%CI，0.83~0.96)。4小时内给药较晚给药平均LOS缩短0.4天。时机与再次入院无关。60.9%的患者在抵达后4小时内使用抗生素，超过50%的患者在不考虑医院特点的情况下使用抗生素。结论：在随机抽样的老年社区获得性肺炎患者中，在到达后4小时内使用抗生素与死亡率和损失减少有关，这些患者在门诊期间没有接受抗生素治疗。4小时内给药可以防止医疗保险人群死亡，为医院节省成本，对大多数住院患者来说是可行的。
Background: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital.Methods: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS).Results: Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics.Conclusions: Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.