據(jù)5月26日刊JAMA上的一則研究披露,在因慢性阻塞性肺?。–OPD)急性惡化而住院治療的患者中,,與那些接受抗菌素治療較晚或完全沒有接受抗菌素的人相比,那些在入院后頭2天中接受了抗菌素的患者的結(jié)果會(huì)有所改善,其中包括他們上呼吸機(jī)的可能性較低且再次入院治療的可能性也較低,。
COPD是美國排第四位的主要死亡原因,,至少有1200萬的美國人受到該疾病的影響,。文章的作者寫道:“COPD的急性惡化與每年超過60萬例的住院有關(guān),,其所造成的直接費(fèi)用超過200億美元,。有關(guān)的治療方針建議對(duì)COPD的急性惡化給予抗菌素的治療,,但這一建議所循的證據(jù)是基于小型、異源性的試驗(yàn),,其中較少有試驗(yàn)包括了住院的患者,。”
Baystate Medical Center, Springfield, Mass.的Michael B. Rothberg, M.D., M.P.H.及其同僚對(duì)在抗菌素的使用和因COPD的急性惡化而住院的患者的后果之間的關(guān)系進(jìn)行了檢查,,這些患者來自全美國413個(gè)急性護(hù)理機(jī)構(gòu),,時(shí)間是2006年1月至2007年12月,。在所分析的主要結(jié)果中包括了一個(gè)對(duì)治療失敗的復(fù)合測定,治療失敗被定義為入院的第二天就開始使用呼吸機(jī),、住院時(shí)死亡或在出院后的30天內(nèi)因?yàn)镃OPD的急性加劇而重新入院;他們還對(duì)患者住院時(shí)間的長度和住院的費(fèi)用進(jìn)行了檢查,。
在8萬4621名患者中,,有79%的人接受了至少連續(xù)2天的抗菌素治療,。研究人員發(fā)現(xiàn),與那些在入院頭2天沒有接受抗菌素治療的患者相比,, 這些接受了抗菌素治療的病人在入院的第二天后上呼吸機(jī)的可能性較?。?.07% vs. 1.80%),、住院 時(shí)死亡率較低(1.04% vs. 1.59%),、治療失敗率較低(9.77% vs. 11.75%)以及因?yàn)镃OPD的急性惡化而重新入院的比率較低 (7.91% vs. 8.79%),。接受或沒有接受抗菌素治療的病人的住院時(shí)間的長短相似,但接受了抗菌素治療的患者的治療成本較低,。
與沒有接受抗菌素治療的患者相比,,那些接受了抗菌素制劑的患者因?yàn)殡y辨梭狀芽孢桿菌的感染而再次入院的比例較高。在經(jīng)過進(jìn)一步的分析之后,在接受了抗菌素治療的患者中其發(fā)生治療失敗的風(fēng)險(xiǎn)要較低,。文章的作者寫道:“根據(jù)治療失敗風(fēng)險(xiǎn)而進(jìn)行的層級(jí)分析發(fā)現(xiàn),,在所有的亞組病人中,都存在著類似程度的裨益,。”
文章的作者得出結(jié)論:“…在獲得更多的數(shù)據(jù)之前,,對(duì)COPD的急性惡化患者常規(guī)使用抗菌素可能是適當(dāng)?shù)摹?rdquo;(生物谷Bioon.com)
生物谷推薦原文出處:
JAMA. 2010;303(20):2035-2042.
Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Michael B. Rothberg, MD, MPH; Penelope S. Pekow, PhD; Maureen Lahti, MBBS, MPH; Oren Brody, MD; Daniel J. Skiest, MD; Peter K. Lindenauer, MD, MSc
Context Guidelines recommend antibiotic therapy for acute exacerbations of chronic obstructive pulmonary disease (COPD), but the evidence is based on small, heterogeneous trials, few of which include hospitalized patients.
Objective To compare the outcomes of patients treated with antibiotics in the first 2 hospital days with those treated later or not at all.
Design, Setting, and Patients Retrospective cohort of patients aged 40 years or older who were hospitalized from January 1, 2006, through December 31, 2007, for acute exacerbations of COPD at 413 acute care facilities throughout the United States.
Main Outcome Measures A composite measure of treatment failure, defined as the initiation of mechanical ventilation after the second hospital day, inpatient mortality, or readmission for acute exacerbations of COPD within 30 days of discharge; length of stay, and hospital costs.
Results Of 84 621 patients, 79% received at least 2 consecutive days of antibiotic treatment. Treated patients were less likely than nontreated patients to receive mechanical ventilation after the second hospital day (1.07%; 95% confidence interval [CI], 1.06%-1.08% vs 1.80%; 95% CI, 1.78%-1.82%), had lower rates of inpatient mortality (1.04%; 95% CI, 1.03%-1.05% vs 1.59%; 95% CI, 1.57%-1.61%), and had lower rates of readmission for acute exacerbations of COPD (7.91%; 95% CI, 7.89%-7.94% vs 8.79%; 95% CI, 8.74%-8.83%). Patients treated with antibiotic agents had a higher rate of readmissions for Clostridium difficile (0.19%; 95% CI, 0.187%-0.193%) than those who were not treated (0.09%; 95% CI, 0.086%-0.094%). After multivariable adjustment, including the propensity for antibiotic treatment, the risk of treatment failure was lower in antibiotic-treated patients (odds ratio, 0.87; 95% CI, 0.82-0.92). A grouped treatment approach and hierarchical modeling to account for potential confounding of hospital effects yielded similar results. Analysis stratified by risk of treatment failure found similar magnitudes of benefit across all subgroups.
Conclusion Early antibiotic administration was associated with improved outcomes among patients hospitalized for acute exacerbations of COPD regardless of the risk of treatment failure.