IF 4.7 3区 医学 Q1 INFECTIOUS DISEASES
Takahiro Takazono, Naoki Hosogaya, Yoshiyuki Saito, Masahiko Takemura, Naoki Iwanaga, Noriho Sakamoto, Junichi Hirayama, Rie Ueno, Hiroshi Mukae
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引用次数: 0

摘要

简介:广谱抗菌药物是治疗社区获得性肺炎(CAP)的常用药物,但不必要的用药可能会导致不良事件和不良疗效。本研究旨在了解广谱抗假丝酵母β-内酰胺类药物的使用对 CAP 住院患者的临床疗效和医疗资源利用率(HCRU)的影响,以及耐药病原体(DRP)的低风险性:这项历史队列研究回顾了日本的医院索赔数据库(2018年1月至12月),纳入了年龄≥20岁、因CAP接受静脉抗菌治疗的住院患者。DRP风险高者被排除在外。根据初始抗菌治疗方案,将患者分为广谱(抗假性β-内酰胺类药物治疗)组和窄谱(非抗假性β-内酰胺类药物治疗)组。本研究采用反向治疗概率加权法(IPTW)将30天住院死亡率作为主要结果进行评估,以调整两组之间的差异,并将HCRU作为探索性分析:共分析了 15617 名患者(广谱组 2627 人,窄谱组 12990 人)。广谱组的 30 天死亡率为 10.6%,高于窄谱组(5.3%)。此外,与 IPTW 后的窄谱组相比,广谱组的 30 天死亡率也有所上升(调整后的几率比为 1.77;95% 置信区间为 1.52-2.06;P 结论:广谱组患者的 30 天死亡率高于窄谱组患者:对于 DRP 风险较低的 CAP,最初使用抗假名β-内酰胺类药物与不良预后相关,包括死亡和高 HCRU。因此,在治疗 CAP 时应审慎选择初始抗菌药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Broad-Spectrum Antimicrobials on Patients with Community-Acquired Pneumonia with Low Risk for Drug-Resistant Pathogens: Historical Cohort Study in Japan.

Introduction: Broad-spectrum antimicrobials are commonly administered for community-acquired pneumonia (CAP); however, unnecessary administration may cause adverse events and poor outcomes. This study aimed to understand the impact of broad-spectrum anti-pseudomonal β-lactam use on clinical outcomes and healthcare resource utilization (HCRU) in inpatients with CAP and a low risk of drug-resistant pathogens (DRPs).

Methods: This historical cohort study reviewed Japan's hospital claims database (January to December of 2018) and included inpatients aged ≥ 20 years who received intravenous antimicrobial therapy for CAP. Those with high DRP risk were excluded. According to the initial antimicrobial regimen, patients were divided into broad-spectrum (anti-pseudomonal β-lactam therapy) and narrow-spectrum (non-anti-pseudomonal β-lactam therapy) groups. This study evaluated 30-day hospital mortality as a primary outcome using inverse probability of treatment weighting (IPTW) to adjust for differences between both groups and HCRU as an exploratory analysis.

Results: A total of 15,617 patients were analyzed (2627 in the broad-spectrum group and 12,990 in the narrow-spectrum group). In the broad-spectrum group, the 30-day mortality rate was 10.6%, which was higher than that in the narrow-spectrum group (5.3%). Furthermore, it was associated with an increased 30-day mortality compared with the narrow-spectrum group after IPTW (adjusted odds ratio, 1.77; 95% confidence interval, 1.52-2.06; p < 0.001). The mean inpatient cost was USD 6139 and USD 5184 for the broad- and narrow-spectrum groups, respectively.

Conclusions: The initial use of anti-pseudomonal β-lactams for CAP with low DRP risk is associated with poor outcomes, including death and high HCRU. Thus, initial antimicrobials should be judiciously selected for CAP management.

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来源期刊
Infectious Diseases and Therapy
Infectious Diseases and Therapy Medicine-Microbiology (medical)
CiteScore
8.60
自引率
1.90%
发文量
136
审稿时长
6 weeks
期刊介绍: Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.
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