Reply to Henriksen and Brabrand.
Reply to Henriksen and Brabrand.
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回复 Henriksen 和 Brabrand。
DOI：
10.1093/cid/ciw385
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Rothberg,MichaelB
中科院分区：
文献类型：
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作者：
Belforti,RaquelK;Lindenauer,PeterK;Priya,Aruna;Pekow,PenelopeS;Rothberg,MichaelB
TO THE EDITOR—We read with great interest the study by Belforti et al on the outcomes of hospitalized patients with community-acquired pneumonia (CAP) and the association with the initial route of fluoroquinolone treatment [1]. The authors compared the administration of peroral fluoroquinolones with intravenous (IV) administration and found no differences in hospital mortality or signs of late clinical deterioration. First, we would like to commend the authors for an interesting study, especially for the novel way of assessing this healthcare-related issue. We agree with the authors in their statement that they “... performed rigorous adjustment and [our] propensity model had a high c-statistic”[1]. However, despite this, we believe that the variables used to define the severity of the pneumonia, namely, transfer to an intensive care unit (ICU), invasive mechanical ventilation initiated after the second hospital day, and the use of vasopressors, are markers that are too broad for measuring severity and deterioration. Especially given that only 4.2% of the entire cohort had clinical deterioration requiring late ICU transfer. Patients who present to the hospital with CAP are a heterogeneous group. Some present without signs of organ dysfunction, while others have multiple organ dysfunction at admission but do not require ICU transfer. The severity scores used in emergency departments worldwide to categorize patients at admission all depend on clinical information such as vital signs, including altered mental state and laboratory values [2]. This information was missing from Belforti et al’s study.
