Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia.
Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia.
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β-内酰胺加强力霉素对社区获得性肺炎住院患者的疗效。
DOI：
10.1093/cid/ciab863
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Mortensen,EricM
中科院分区：
文献类型：
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作者：
Uddin,Moe;Mohammed,Turab;Metersky,Mark;Anzueto,Antonio;Alvarez,CarlosA;Mortensen,EricM
背景尽管临床实践指南建议使用多西环素作为一些住院肺炎患者联合治疗的一部分，但支持这一建议的证据很少。我们的目的是检查 β-内酰胺加强力霉素与社区获得性肺炎住院患者死亡率之间的关系。方法我们确定了 2002-2012 财年美国退伍军人事务部任何一家医院收治的年龄 >65 岁且出院诊断为肺炎的患者。我们排除了那些未接受符合 2019 年美国胸科学会/美国传染病学会 (ATS/IDSA) 临床实践指南的抗生素治疗的患者。使用倾向评分匹配，我们检查了强力霉素与 30 天和 90 天死亡率的关联。结果我们的总体队列由 70533 名患者组成，其中 5282 名 (7.49%) 接受了强力霉素。接受β-内酰胺+多西环素治疗的患者未经调整的30天死亡率为6.4%，而未接受治疗的患者为9.1% (P< .0001)，接受β-内酰胺+多西环素治疗的患者的90天死亡率为13.8%，而未接受治疗的患者为16.8% (P< .0001)。在倾向评分匹配模型中，接受多西环素治疗的患者的 30 天（比值比 0.72，95% 置信区间 [CI]，0.63–.84）和 90 天（0.83，95% CI，0.74–.92）死亡率均显着降低。结论在这项回顾性观察队列研究中，我们发现使用多西环素作为指南一致的一部分与不使用多西环素的治疗方案相比，使用抗生素治疗的 30 天和 90 天死亡率较低。虽然这支持了包括多西环素在内的抗生素治疗方案的安全性和有效性，但还需要更多的研究，特别是随机临床试验来证实这一点。
BackgroundDespite clinical practice guideline recommendations to use doxycycline as part of combination therapy for some patients hospitalized with pneumonia, there is minimal evidence supporting this recommendation. Our aim was to examine the association between beta-lactam plus doxycycline and mortality for patients hospitalized with community-acquired pneumonia.MethodsWe identified patients >65 years of age admitted to any US Department of Veterans Affairs hospital in fiscal years 2002–2012 with a discharge diagnosis of pneumonia. We excluded those patients who did not receive antibiotic therapy concordant with the 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) clinical practice guidelines. Using propensity score matching, we examined the association of doxycycline with 30- and 90-day mortality.ResultsOur overall cohort was comprised of 70533 patients and 5282 (7.49%) received doxycycline. Unadjusted 30-day mortality was 6.4% for those who received a beta-lactam plus doxycycline versus 9.1% in those who did not (P< .0001), and 90-day mortality was 13.8% for those who received a beta-lactam + doxycycline versus 16.8% for those who did not (P< .0001). In the propensity score matched models, both 30- (odds ratio 0.72, 95% confidence interval [CI], .63–.84) and 90-day (0.83, 95% CI, .74–.92) mortality were significantly lower for those who received doxycycline.ConclusionsIn this retrospective observational cohort study, we found that doxycycline use, as part of guideline-concordant antibiotic therapy, was associated with lower 30- and 90-day mortality than regimens without doxycycline. While this supports the safety and effectiveness of antibiotic regimes that include doxycycline, additional studies, especially randomized clinical trials, are needed to confirm this.