Examination of high-antibiotic users in a multi-institutional cohort of chronic rhinosinusitis patients.
Examination of high-antibiotic users in a multi-institutional cohort of chronic rhinosinusitis patients.
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DOI：
10.1002/alr.21903
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发表时间：
2017-04
影响因子：
6.4
通讯作者：
Smith TL
中科院分区：
文献类型：
--
作者：
Ramakrishnan VR;Mace JC;Soler ZM;Smith TL
除了对抗生素过度使用的已知担忧外，最近的研究表明，过度使用抗生素与较差的长期健康状况有关。鉴于鼻窦炎是门诊抗生素处方的主要情况，我们旨在评估CRS中抗生素使用增加的相关特征。本分析纳入了一项评估治疗结果的前瞻性、多机构、观察性队列研究的成年CRS患者。研究参与者被要求报告在过去的90天中使用全身抗生素治疗鼻窦疾病的天数。评估患者人口统计学、疾病特征和疾病严重程度。来自4家机构的561例患者被纳入分析，前90天的平均抗生素使用为17.4 +/ - 22.4。在疾病严重程度的客观测量（CT、内窥镜检查、BSIT评分）方面，抗生素使用组之间没有发现差异，然而，患者报告的症状负担（SNOT-22、RSDI）的增加与抗生素使用的增加有关。报告使用抗生素最多的患者年龄较大（p=0.004），但没有发现种族或性别差异。过敏症、哮喘、糖尿病、抑郁症或纤维肌痛的合并症诊断与抗生素使用增加无关。根据文献建议，CRSwNP患者使用抗生素的可能性较小。ESS显著减少抗生素的使用。CRS中抗生素使用的可变性似乎是由症状负担驱动的，独立于疾病严重程度、患者人口统计学和合并症存在的客观测量。明确的指南对于确定CRS中抗生素的适当使用至关重要。
In addition to known concerns regarding antibiotic overuse, recent research indicates that excessive antibiotic use is associated with poorer long-term health. Given that rhinosinusitis is the leading condition accounting for antibiotic prescriptions in the ambulatory setting, we aimed to evaluate characteristics associated with greater antibiotic use in CRS. Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study evaluating treatment outcomes were included in this analysis. Study participants were asked to report the number of days out of the previous 90 days that systemic antibiotics were taken for sinus disease. Patient demographics, disease characteristics, and measures of disease severity were evaluated. 561 patients from 4 institutions were included in the analysis, with mean antibiotic use of 17.4 +/−22.4 out of the prior 90 days. No differences between antibiotic-use groups were found for objective measures of disease severity (CT, endoscopy, BSIT scores), however, increased patient-reported symptom burden (SNOT-22, RSDI) was associated with more antibiotic use. Patients reporting the most antibiotic use were older (p=0.004) but no ethnic or gender differences were seen. Comorbid diagnoses of allergy, asthma, diabetes, depression, or fibromyalgia, were not associated with increased antibiotic use. In accordance with literature recommendations, CRSwNP patients were less likely to have used antibiotics. ESS significantly decreased antibiotic use. Variability in antibiotic use in CRS appears to be driven by symptom burden, independent of objective measures of disease severity, patient demographics, and presence of comorbid disease. Clear guidelines are essential to define appropriate antibiotic use in CRS.