Application of a Risk Score to Identify Older Adults with Community-Onset Pneumonia Most Likely to Benefit From Empiric Pseudomonas Therapy.
Application of a Risk Score to Identify Older Adults with Community-Onset Pneumonia Most Likely to Benefit From Empiric Pseudomonas Therapy.
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DOI：
10.1002/phar.1891
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发表时间：
2017-02
期刊：
影响因子：
4.1
通讯作者：
Mortensen EM
中科院分区：
文献类型：
--
作者：
Frei CR;Rehani S;Lee GC;Boyd NK;Attia E;Pechal A;Britt RS;Mortensen EM
评估经验性假单胞菌药物治疗对社区肺炎住院患者30天死亡率的影响，根据其耐药病原体风险(低、中、高)进行分层。回顾性队列研究。退伍军人健康管理局数据库。在2002至2007财政年度，共有50,119名年龄至少65岁的肺炎住院患者在入院后48小时内接受抗生素治疗；根据入院后48小时内接受抗生素的情况，患者被分成经验性假单胞菌治疗组(31,027名患者)和非假单胞菌治疗组(19,092名患者)。最近开发的临床预测评分系统根据患者对耐药病原体的风险对社区肺炎患者进行分层，以确定哪些患者可能从经验性假单胞菌治疗中受益，哪些患者可以免除抗假单胞菌治疗；患者被分为低风险组(68%)、中风险组(21%)和高风险组(11%)。在50119名患者中，62%接受了假单胞菌治疗。所有原因导致的30天死亡率是主要结果。经验性假单胞菌治疗(调整后的优势比0.72，95%可信区间0.62-0.84)与高风险组中较低的30天死亡率相关，但与低风险组或中风险组无关。对耐药病原体患者应用风险评分可以确定可能受益于经验性假单胞菌治疗的患者。广泛使用这一评分可以减少低风险到中等风险患者中抗假单胞菌抗生素的过度使用，并提高高危患者的存活率。
To assess the impact of empiric Pseudomonas pharmacotherapy on 30-day mortality in hospitalized patients with community-onset pneumonia stratified according to their risk (low, medium, or high) of drug-resistant pathogens. Retrospective cohort study. Veterans Health Administration database. A total of 50,119 patients who were at least 65 years of age, hospitalized with pneumonia, and received antibiotics within 48 hours of admission between fiscal years 2002 and 2007; patients were stratified into empiric Pseudomonas therapy (31,027 patients) and no Pseudomonas therapy (19,092 patients) groups based on antibiotics received during their first 48 hours of admission. A recently developed clinical prediction scoring system that stratifies patients with community-onset pneumonia according to their risk of drug-resistant pathogens was used to identify patients who were likely to benefit from empiric Pseudomonas therapy as well as those in whom antipseudomonal therapy could be spared; patients were classified into low-risk (68%), medium-risk (21%), and high-risk (11%) groups. Of the 50,119 patients, 62% received Pseudomonas therapy. All-cause 30-day mortality was the primary outcome. Empiric Pseudomonas therapy (adjusted odds ratio 0.72, 95% confidence interval 0.62-0.84) was associated with lower 30-day mortality in the high-risk group but not the low- or medium-risk groups. Application of a risk score for patients with drug-resistant pathogens can identify patients likely to benefit from empiric Pseudomonas therapy. Widespread use of this score could reduce overuse of anti-Pseudomonas antibiotics in low- to medium-risk patients and improve survival in high-risk patients.