The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia
The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia
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DOI：
10.1186/cc3934
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发表时间：
2006-01-01
期刊：
影响因子：
15.1
通讯作者：
Pugh, Jacqueline
中科院分区：
文献类型：
--
作者：
Mortensen, Eric M.;Restrepo, Marcos I.;Pugh, Jacqueline
简介 国家临床实践指南为重症社区获得性肺炎患者推荐了具体的经验性抗菌治疗方案。然而，缺乏证据证实许多这些方案可以提高死亡率。我们的目的是确定与其他推荐的抗菌疗法相比，经验性使用β-内酰胺联合氟喹诺酮类药物与重症社区获得性肺炎住院患者死亡率之间的关系。方法在两家三级教学医院进行了一项回顾性观察研究。符合条件的受试者因社区获得性肺炎的诊断而入院，并进行了胸部 X 光检查和与此一致的出院 ICD-9 诊断。如果受试者在入院期间仅接受“安慰措施”、从另一家急症护理医院转院、不符合严重肺炎标准或接受不符合指南的抗生素治疗，则受试者被排除在外。在对包括倾向评分在内的潜在混杂因素进行调整后，使用多变量逻辑回归模型来评估 30 天死亡率与使用 β-内酰胺抗生素与氟喹诺酮类药物与其他符合指南的治疗方法之间的关联。结果 提取了两家医院 172 名受试者的数据。平均年龄为 63.5 岁 (SD 15.0)。人口中88%为男性； 91% 的患者通过急诊科入院，62% 的患者在入院后 24 小时内入住重症监护室。 30 天死亡率为 19.8%。调整潜在混杂因素后，β-内酰胺类药物与氟喹诺酮类药物联合使用（比值比 2.71，95% 置信区间 1.2 至 6.1）与死亡率增加相关。 结论 与其他符合指南的抗菌治疗方案相比，使用 β-内酰胺类药物和氟喹诺酮类药物进行初始经验性抗菌治疗与严重肺炎患者的短期死亡率增加相关。需要进一步研究来确定针对严重社区获得性肺炎患者的适当经验性抗菌治疗的范围。
Introduction National clinical practice guidelines have recommended specific empiric antimicrobial regimes for patients with severe community-acquired pneumonia. However, evidence confirming improved mortality with many of these regimes is lacking. Our aim was to determine the association between the empiric use of a beta-lactam with fluoroquinolone, compared with other recommended antimicrobial therapies, and mortality in patients hospitalized with severe community-acquired pneumonia.Methods A retrospective observational study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of community-acquired pneumonia and had a chest X-ray and a discharge ICD-9 diagnosis consistent with this. Subjects were excluded if they received 'comfort measures only' during the admission, had been transferred from another acute care hospital, did not meet criteria for severe pneumonia, or were treated with non-guideline-concordant antibiotics. A multivariable logistic regression model was used to assess the association between 30-day mortality and the use of a beta-lactam antibiotic with a fluoroquinolone compared with other guideline-concordant therapies, after adjustment for potential confounders including a propensity score.Results Data were abstracted on 172 subjects at the two hospitals. The mean age was 63.5 years (SD 15.0). The population was 88% male; 91% were admitted through the emergency department and 62% were admitted to the intensive care unit within the first 24 hours after admission. Mortality was 19.8% at 30 days. After adjustment for potential confounders the use of a beta-lactam with a fluoroquinolone ( odds ratio 2.71, 95% confidence interval 1.2 to 6.1) was associated with increased mortality.Conclusion The use of initial empiric antimicrobial therapy with a beta-lactam and a fluoroquinolone was associated with increased short-term mortality for patients with severe pneumonia in comparison with other guideline-concordant antimicrobial regimes. Further research is needed to determine the range of appropriate empiric antimicrobial therapies for patients with severe community-acquired pneumonia.