Juliette Pinot, Serge Gilberg, Cédric Laouénan, Toni Alfaiate, Marie Ecollan, Fanny Cussac, Raphaël Pecqueur, Marie-Pierre Revel, Cyrille Vartanian, Henri Partouche, Xavier Duval, Josselin Le Bel
{"title":"全科医生在社区获得性肺炎治疗中胸部 X 射线造影结果与抗生素使用的关系。","authors":"Juliette Pinot, Serge Gilberg, Cédric Laouénan, Toni Alfaiate, Marie Ecollan, Fanny Cussac, Raphaël Pecqueur, Marie-Pierre Revel, Cyrille Vartanian, Henri Partouche, Xavier Duval, Josselin Le Bel","doi":"10.1370/afm.3179","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.</p><p><strong>Methods: </strong>We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.</p><p><strong>Results: </strong>A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (<i>P</i> < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.</p><p><strong>Conclusions: </strong>For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 6","pages":"509-517"},"PeriodicalIF":4.4000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588363/pdf/","citationCount":"0","resultStr":"{\"title\":\"Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners.\",\"authors\":\"Juliette Pinot, Serge Gilberg, Cédric Laouénan, Toni Alfaiate, Marie Ecollan, Fanny Cussac, Raphaël Pecqueur, Marie-Pierre Revel, Cyrille Vartanian, Henri Partouche, Xavier Duval, Josselin Le Bel\",\"doi\":\"10.1370/afm.3179\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.</p><p><strong>Methods: </strong>We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.</p><p><strong>Results: </strong>A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (<i>P</i> < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.</p><p><strong>Conclusions: </strong>For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.</p>\",\"PeriodicalId\":50973,\"journal\":{\"name\":\"Annals of Family Medicine\",\"volume\":\"22 6\",\"pages\":\"509-517\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11588363/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Family Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1370/afm.3179\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Family Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1370/afm.3179","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Relation Between Chest Radiography Results and Antibiotic Initiation in Community-Acquired Pneumonia Management by General Practitioners.
Purpose: For most guidelines, diagnosis of community-acquired pneumonia (CAP) is based on a combination of clinical signs and focal consolidation visible on chest radiographs (CRs). Our objective was to analyze antibiotic initiation by general practitioners for patients with suspected CAP according to CR.
Methods: We conducted a prospective cross-sectional study in general practice in France. From November 2017 to December 2019, adult patients with clinically suspected CAP after CR were included. Radiographs were categorized as CAP positive or CAP negative. We analyzed patient characteristics and antibiotic initiation according to CR results.
Results: A total of 259 patients were included in the study. Median age was 58.0 years (interquartile range, 41.0-71.0 years); 249 (96.1%) patients had not received antibiotics before inclusion, and 144 (55.6%) had a positive CR. Patients with positive CR were clinically more severe than those with negative CR, with longer-lasting symptoms. Antibiotics were initiated for 142/143 (99.3% [95% CI, 97.9%-100.0%]) patients with positive CR and 79/115 (68.7% [95% CI, 60.2%-77.2%]) with negative CR (P < .001). Among the 115 CR-negative patients, clinical characteristics that were significantly different between patients for whom antibiotics were initiated or not did not appear to be clinically relevant.
Conclusions: For patients with suspected CAP, general practitioners systematically took into account results of positive CRs to initiate antibiotics and took much less account of negative CRs. These results justify clarification of what should be done in cases of clinical suspicion of CAP without radiologic confirmation.
期刊介绍:
The Annals of Family Medicine is a peer-reviewed research journal to meet the needs of scientists, practitioners, policymakers, and the patients and communities they serve.