背景:选择与临床实践指南一致的经验性抗生素治疗社区获得性肺炎(CAP)与改善这种感染的短期结局有关,但它是否也与长期结局相关尚不清楚.
目的:对因CAP住院的老年患者进行初始抗生素治疗的指南一致性是否与因感染住院而存活的患者的1年全因和心血管死亡风险有关?
方法:我们确定了在安大略省渥太华医院因CAP住院而存活的1909名老年(>65岁)患者加拿大2004年至2015年。将患者信息与医院和省级数据集联系起来,我们分析了他们的CAP初始抗生素治疗的选择是否符合当前的临床实践指南,以及指南一致性是否与他们的指数CAP住院后的1年全因死亡率和心血管死亡率相关,同时调整他们的1年预期死亡风险,CAP严重性,和以前的肺炎入院史,心肌梗塞,心力衰竭或脑血管疾病。
结果:选择符合指南的抗生素治疗与CAP后1年全因死亡率降低趋势相关(风险比[HR]0.82,95CI0.65-1.04,p=0.099)。此外,指南一致的抗生素治疗与CAP入院1年后心血管死亡风险显著降低近50%相关(HR0.53,95CI0.34~0.80,p=0.003).
结论:在老年住院患者中使用指南一致的抗生素治疗CAP与CAP后1年心血管死亡风险的显著降低相关。这一发现进一步支持了CAP治疗的当前临床实践指南建议。
Selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) that is concordant with clinical practice
guidelines has been associated with improved short-term outcomes of this infection, but whether it is also associated with longer-term outcomes is unknown.
Is
guideline-concordance of the initial antibiotic treatment given to older adult patients hospitalized with CAP associated with the 1-year all-cause and cardiovascular mortality risk of those patients who survive hospitalization for this infection?
A total of 1,909 older (> 65 years of age) patients were identified who survived hospitalization for CAP at The Ottawa Hospital (Ontario, Canada) between 2004 and 2015. Linking patients\' information to hospital and provincial data sets, this study analyzed whether the selection of the initial antibiotic therapy for their CAP was concordant with current clinical practice
guidelines, and whether
guideline-concordance was associated with 1-year all-cause and cardiovascular mortality following their index CAP hospitalization. Adjustments were made for the patients\' overall 1-year expected death risk; CAP severity; and history of previous pneumonia admissions, myocardial infarction, heart failure, or cerebrovascular disease.
Selection of guideline-concordant antibiotic therapy was associated with a trend towards lower all-cause mortality at 1 year post-CAP (hazard ratio, 0.82; 95% CI, 0.65-1.04; P = .099). Furthermore, the use of guideline-concordant antibiotic therapy was associated with a significant almost 50% reduction in cardiovascular death risk 1 year following CAP admission (hazard ratio, 0.53; 95% CI, 0.34-0.80; P = .003).
Use of guideline-concordant antibiotic therapy for CAP treatment in older hospitalized patients is associated with a significant reduction in the risk of cardiovascular death at 1 year post-CAP. This finding further supports current clinical practice
guideline recommendations for CAP treatment.