Antibiotic treatment is associated with reduced risk of a subsequent exacerbation in obstructive lung disease: an historical population based cohort study
Antibiotic treatment is associated with reduced risk of a subsequent exacerbation in obstructive lung disease: an historical population based cohort study
复制标题
DOI：
10.1136/thx.2008.095349
复制
发表时间：
2008-11-01
期刊：
影响因子：
10
通讯作者：
Prins, J. M.
中科院分区：
文献类型：
--
作者：
Roede, B. M.;Bresser, P.;Prins, J. M.
目的：在一项基于人群的队列研究中，包括使用维持药物治疗阻塞性肺疾病的患者，评价了用口服皮质类固醇治疗急性加重（OS）或（OSA）抗生素后随后急性加重的风险。方法：Pharmo数据库包括荷兰200多万受试者的药物分配记录。符合条件的患者年龄≥ 50岁，在2003年接受≥ 2次每日使用的吸入性β 2受体激动剂、抗胆碱能药物和/或皮质类固醇处方，并且在2006年1月1日之前至少经历过一次急性加重。加重定义为OS或OSA处方。使用Kaplan-Meier生存分析比较第二次和第三次急性加重的时间。使用多变量考克斯复发事件生存分析确定了新的急性加重的独立决定因素。结果：49 599例使用维持药物的患者中，18 928例至少有一次急性加重;在52%的患者中，已添加抗生素。OS组和OSA组的潜在混杂因素相当。OS组第二次加重的中位时间为321天，OSA组为418天（p < 0.001）;第二次和第三次加重之间的中位时间为127天和240天（p < 0.001）。OSA的保护作用在治疗后的前3个月最为明显（风险比（HR）0.62; 99% CI 0.60 - 0.65）。在OSA组中，随访期间的死亡率较低（HR 0.82; 99%CI 0.66至0.98）。结论：除口服糖皮质激素外，抗生素治疗与下一次加重的时间延长相关，并降低了发生新加重的风险。
Objectives: The risk of a subsequent exacerbation after treatment of an exacerbation with oral corticosteroids without ( OS) or with (OSA) antibiotics was evaluated in a historical population based cohort study comprising patients using maintenance medication for obstructive lung disease.Methods: The Pharmo database includes drug dispensing records of more than 2 million subjects in The Netherlands. Eligible were patients >= 50 years who in 2003 were dispensed >= 2 prescriptions of daily used inhaled beta(2) agonists, anticholinergics and/or corticosteroids, and experienced at least one exacerbation before 1 January 2006. Exacerbation was defined as a prescription of OS or OSA. The times to the second and third exacerbations were compared using Kaplan-Meier survival analysis. Independent determinants of new exacerbations were identified using multivariable Cox recurrent event survival analysis.Results: Of 49 599 patients using maintenance medication, 18 928 had at least one exacerbation; in 52%, antibiotics had been added. The OS and OSA groups were comparable for potential confounding factors. Median time to the second exacerbation was 321 days in the OS group and 418 days in the OSA group (p < 0.001); and between the second and third exacerbation 127 vs 240 days (p < 0.001). The protective effect of OSA was most pronounced during the first 3 months following treatment (hazard ratio (HR) 0.62; 99% CI 0.60 to 0.65). In the OSA group, mortality during follow-up was lower (HR 0.82; 99% CI 0.66 to 0.98).Conclusion: Treatment with antibiotics in addition to oral corticosteroids was associated with a longer time to the next exacerbation, and a decreased risk of developing a new exacerbation.