Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice
Predictors for antibiotic prescribing in patients with exacerbations of COPD in general practice
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DOI：
10.1177/1753465812472387
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发表时间：
2013-06-01
影响因子：
4.3
通讯作者：
Caballero, Lidia
中科院分区：
文献类型：
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作者：
Llor, Carl;Bjerrum, Lars;Caballero, Lidia
背景资料：本研究的目的是描述慢性阻塞性肺疾病急性加重期（AECOPD）患者的抗生素处方率，分析抗生素处方的预测因素，并探讨使用C反应蛋白（CRP）快速检测的影响。方法：2008年1月和2月进行了一项横断面研究在初级保健。来自6个国家（丹麦、瑞典、立陶宛、俄罗斯、西班牙和阿根廷）的全科医生（GP）在3周期间登记了所有AECOPD患者。使用两个分层水平（i）患者和（ii）医生）估计多水平logistic回归模型，并用于分析抗生素处方与抗生素用途：患者年龄和性别、病程、症状和加重体征之间的相关性结果：617名全科医生共登记AECOPD患者1233例，其中AECOPD患者1233例。共有970例患者（79%）接受了抗生素处方，从49%（丹麦）到93%（俄罗斯）不等。脓痰的存在是抗生素治疗的最强预测因子（比值比[OR] 8.7; 95%置信区间[CI] 5.9-12.8）。CRP测定主要在丹麦和瑞典进行，其使用是抗生素治疗的最强保护因素（OR 0.3; 95% CI 0.2-0.6）。使用CRP检测的GP对脓痰的加权低于未使用CRP检测的GP。CRP值有很大的影响抗生素处方率。结论：抗生素治疗AECOPD是非常高的。这项研究表明，进行CRP快速检测的全科医生比不进行快速检测的人处方更少的抗生素。
Background: The aim of this study was to describe the antibiotic prescribing rate in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), to analyse predictors for antibiotic prescribing and to explore the influence of the use C-reactive protein (CRP) rapid test.Methods: A cross-sectional study was carried out in January and February 2008 in primary care. General practitioners (GPs) from six countries (Denmark, Sweden, Lithuania, Russia, Spain and Argentina) registered all patients with AECOPD during a 3-week period. A multilevel logistic regression model was estimated using two hierarchical levels, (i) patients and (ii) physicians, and was used to analyse the association between antibiotic prescribing and potential predictors for antibiotic use: patients' age and gender, duration and symptoms and signs of exacerbations (fever, cough, dyspnoea, sputum volume and purulence) and the results of the CRP test.Results: A total of 617 GPs registered 1233 patients with AECOPD. A total of 970 patients (79%) were prescribed antibiotics, varying from 49% (Denmark) to 93% (Russia). The presence of purulent sputum was the strongest predictor for antibiotic treatment (odds ratio [OR] 8.7; 95% confidence interval [CI] 5.9-12.8). CRP determination was carried out mainly in Denmark and Sweden and its use was the strongest protective factor for antibiotic therapy (OR 0.3; 95% CI 0.2-0.6). GPs that used CRP testing weighted purulent sputum lower than GPs who did not use CRP testing. CRP values had a strong influence on the antibiotic prescribing rate.Conclusions: Antibiotic treatment for AECOPD is very high. This study shows that GPs performing CRP rapid tests prescribe fewer antibiotics than those who do not.