Extended-spectrum antibiotics for community-acquired pneumonia with a low risk for drug-resistant pathogens
Extended-spectrum antibiotics for community-acquired pneumonia with a low risk for drug-resistant pathogens
复制标题
广谱抗生素治疗耐药病原体风险较低的社区获得性肺炎
DOI：
10.1016/j.ijid.2022.09.015
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发表时间：
2022
影响因子：
8.4
通讯作者：
Hasegawa Yoshinori
中科院分区：
文献类型：
--
作者：
Kobayashi Hironori;Shindo Yuichiro;Kobayashi Daisuke;Sakakibara Toshihiro;Murakami Yasushi;Yagi Mitsuaki;Matsuura Akinobu;Sato Kenta;Matsui Kota;Emoto Ryo;Yagi Tetsuya;Saka Hideo;Matsui Shigeyuki;Hasegawa Yoshinori
目的广谱抗生素治疗对耐药病原体（DRPs）风险低的社区获得性肺炎（CAP）患者的潜在危害尚不清楚;然而，DRPs的风险评估对于确定初始抗生素给药至关重要。本研究的目的是评估不必要的广谱治疗对死亡率的影响，这样的patients. MethodsApostereconstructionanalysis后进行了前瞻性多中心观察性研究CAP。采用多变量logistic回归分析评估超广谱治疗对30天死亡率的影响。三个敏感性分析，包括倾向评分分析，以确认结果的鲁棒性，也进行了carried.ResultsAmong 750例CAP患者，416与CAP DRPs的低风险进行了分析，其中，257进行了标准治疗和159进行了扩展频谱治疗。标准治疗组和超广谱治疗组的30天死亡率分别为3.9%和13.8%。初步分析显示，与标准治疗相比，超广谱治疗与30天死亡率增加相关（校正比值比2.82; 95%置信区间1.20-6.66）。敏感性分析的结果是一致的主要analys.ConclusionPhysicians确定经验性抗生素治疗时，应评估DRPs的风险，并应避免管理不必要的广谱抗生素的CAP患者与DRPs的低风险。
ObjectivesThe potential hazards of extended-spectrum antibiotic therapy for patients with community-acquired pneumonia (CAP) with low risk for drug-resistant pathogens (DRPs) remain unclear; however, risk assessment for DRPs is essential to determine the initial antibiotics to be administered. The study objective was to assess the effect of unnecessary extended-spectrum therapy on the mortality of such patients.MethodsApost hocanalysis was conducted after a prospective multicenter observational study for CAP. Multivariable logistic regression analysis was performed to assess the effect of extended-spectrum therapy on 30-day mortality. Three sensitivity analyses, including propensity score analysis to confirm the robustness of findings, were also performed.ResultsAmong 750 patients with CAP, 416 with CAP with a low risk for DRPs were analyzed; of these, 257 underwent standard therapy and 159 underwent extended-spectrum therapy. The 30-day mortality was 3.9% and 13.8% in the standard and extended-spectrum therapy groups, respectively. Primary analysis revealed that extended-spectrum therapy was associated with increased 30-day mortality compared with standard therapy (adjusted odds ratio 2.82; 95% confidence interval 1.20-6.66). The results of the sensitivity analyses were consistent with those of the primary analysis.ConclusionPhysicians should assess the risk for DRPs when determining the empirical antibiotic therapy and should refrain from administering unnecessary extended-spectrum antibiotics for patients with CAP with a low risk for DRPs.