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。

IF 4.4 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
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
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引用次数: 0

摘要

目的:在大多数指南中,社区获得性肺炎(CAP)的诊断依据是临床症状和胸片(CR)上可见的局灶性合并症。我们的目的是分析全科医生根据 CR 对疑似 CAP 患者使用抗生素的情况:我们在法国的全科医生中开展了一项前瞻性横断面研究。从 2017 年 11 月至 2019 年 12 月,纳入了 CR 后临床疑似 CAP 的成年患者。X光片被分为CAP阳性或CAP阴性。我们根据CR结果分析了患者特征和抗生素使用情况:研究共纳入 259 名患者。中位年龄为 58.0 岁(四分位数间距为 41.0-71.0 岁);249 名患者(96.1%)在纳入前未使用过抗生素,144 名患者(55.6%)的 CR 呈阳性。CR 阳性患者的临床症状比 CR 阴性患者更严重,症状持续时间更长。142/143(99.3% [95% CI,97.9%-100.0%])名 CR 阳性患者和 79/115 (68.7% [95% CI,60.2%-77.2%])名 CR 阴性患者开始使用抗生素(P < .001)。在CR阴性的115名患者中,开始使用抗生素与未使用抗生素的患者之间存在显著差异的临床特征似乎与临床无关:结论:对于疑似 CAP 患者,全科医生在启动抗生素治疗时会系统性地考虑 CR 阳性的结果,而对 CR 阴性的考虑较少。这些结果说明,在临床怀疑 CAP 但未经放射学证实的情况下,应该采取哪些措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Annals of Family Medicine
Annals of Family Medicine 医学-医学:内科
CiteScore
3.70
自引率
4.50%
发文量
142
审稿时长
6-12 weeks
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.
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