Abstract：
Guidelines recommend intravenous (IV) ceftriaxone at a dose of 1-2 g/d as empirical treatment in adults hospitalized with community acquired pneumonia (CAP), with the addition of macrolide. We examined whether 1 g/d of IV ceftriaxone is associated with similar clinical outcomes to those of 2 g/d. This is a single-center, retrospective, cohort study of all adult patients hospitalized at Rabin Medical Center between 2015 and 2018 with CAP. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified by univariable and multivariable analyses, using logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A total of 2045 patients were treated with IV ceftriaxone 1 g/d and were and compared to 1944 patients who were treated with 2 g/d. The groups were comparable in their baseline characteristics and their clinical presentation. The 30-day all-cause mortality rate was similar between the groups (301/2045 (14.7%) for 1 g/d vs. 312/1944 (16.0%) for 2 g/d, p = 0.24). The rate of C. difficile infection (CDI) was significantly decreased with 1 g/d compared to 2 g/d (4/2045 (0.2%) vs. 12/1944 (0.6%), p = 0.03) and the length of stay was significantly shorter (median 4 days interquartile range (IQR) 3-7 vs. 5 days IQR 3-8, p = 0.02). None of the blood isolates of Streptococcus pneumoniae were penicillin or ceftriaxone resistant. For hospitalized patients with CAP, IV ceftriaxone 1 g/d was associated with similar mortality rates as IV ceftriaxone 2 g/d, with a decreased rate of CDI and shorter length of stay. Ceftriaxone 1 g/d may be sufficient to treat patients with CAP in countries with low prevalence of drug resistant Streptococcus pneumoniae.
摘要：
指南推荐以1-2g/d的剂量静脉注射头孢曲松作为社区获得性肺炎（CAP）住院的成人的经验性治疗，加入大环内酯。我们检查了静脉注射1g/d头孢曲松是否与2g/d的临床结局相似。这是一个单一的中心，回顾性,2015年至2018年在拉宾医学中心住院的所有成人患者的队列研究。主要结果是30天全因死亡率。通过单变量和多变量分析确定30天全因死亡率的危险因素，采用Logistic回归分析。计算具有95%置信区间(CIs)的赔率比(ORs)。总共2045例患者接受静脉注射头孢曲松1g/d治疗，并与1944例接受2g/d治疗的患者进行比较。两组的基线特征和临床表现具有可比性。两组之间的30天全因死亡率相似（301/2045（14.7％），1g/d与312/1944（16.0%），2g/d，p=0.24）。1g/d与2g/d相比，艰难梭菌感染率（CDI）显着降低（4/2045（0.2％）与12/1944（0.6%），p=0.03），并且住院时间显着缩短（中位数4天的四分位距（IQR）3-7vs.5天IQR3-8，p=0.02）。肺炎链球菌的血液分离株均未对青霉素或头孢曲松耐药。对于住院的CAP患者，静脉注射头孢曲松1g/d与静脉注射头孢曲松2g/d的死亡率相似，CDI率降低，住院时间缩短。头孢曲松1g/d可能足以治疗耐药肺炎链球菌患病率低的国家的CAP患者。
