Guidelines-concordant empiric antimicrobial therapy and mortality in patients with severe community-acquired pneumonia requiring mechanical ventilation

详细信息    查看全文

• 作者：Yukiyo Sakamoto ; MD^a ; ^{ysakamoto-tmd@umin.org} ; Yasuhiro Yamauchi ; MD ; PhD^a ; ^{YAMAUCHIY-INT@h.u-tokyo.ac.jp} ; Hideo Yasunaga ; MD ; PhD^b ; ^{yasunagah-tky@umin.ac.jp} ; Hideyuki Takeshima ; MD^a ; ^{Htakeshima-tky@umin.ac.jp} ; Wakae Hasegawa ; MD^a ; ^{w-hasegawa@umin.ac.jp} ; Taisuke Jo ; MD ; PhD^a ; ^c ; ^{jo-taisuke@umin.ac.jp} ; Hiroki Matsui ; MPH^b ; ^{ptmatsui-tky@umin.ac.jp} ; Kiyohide Fushimi ; MD ; PhD^d ; ^{kfushimi.hci@tmd.ac.jp} ; Takahide Nagase ; MD ; PhD^a ; ^{takahide-tky@umin.ac.jp}
• 关键词：BMI ; body mass index ; BUN ; blood urea nitrogen ; CAP ; community-acquired pneumonia ; CRP ; C-reactive protein ; CURB-65 ; Confusion-Urea-Respiratory rate-Blood pressure-65 ; A-DROP ; Age-Dehydration-Respiratory failure-Orientation disturbance-blood Pressure ; DPC ; Diagnosis Procedure Combination ; ICU ; intensive care unit ; IDSA ; Infectious Diseases Society of America ; JRS ; Japanese Respiratory Society ; SD ; standard deviation
• 刊名：Respiratory Investigation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：55
• 期：1
• 页码：39-44
• 全文大小：341 K
• 卷排序：55

文摘

Community-acquired pneumonia (CAP) has high morbidity and mortality among adults. Several clinical guidelines recommend prompt administration of combined antimicrobial therapy. However, the association between guidelines concordance and mortality in patients with severe pneumonia remains unclear. The present study aimed to examine the impact of guidelines-concordant empiric antimicrobial therapy on 7-day mortality in patients with extremely severe pneumonia who required mechanical ventilation at admission, using a nationwide inpatient database in Japan.MethodsData of CAP patients aged over 20 years who required mechanical ventilation at admission between April 2012 and March 2014 were retrospectively analyzed. Multivariable logistic regression analysis was performed to examine the association between guidelines-concordant empiric antimicrobial therapy and all-cause 7-day mortality, with adjustment for patient backgrounds and pneumonia severity.ResultsThere were a total of 3719 eligible patients, 836 (22.5%) of whom received guidelines-concordant combination therapy. Overall, 7-day mortality was 29.5%. Higher 7-day mortality was associated with advanced age, confusion, lower systolic blood pressure, malignant tumor or immunocompromised state, and C-reactive protein ≥20 mg/dl or infiltration occupying two-thirds of one lung on chest radiography. After adjustment for these variables, guidelines-concordant combined antimicrobial therapy was associated with significantly lower 7-day mortality (odds ratio: 0.78; 95% confidence interval: 0.65–0.95; P=0.013).ConclusionsAdherence to initial empiric treatment as recommended by the guidelines was associated with better short-term prognosis in patients with extremely severe pneumonia who required mechanical ventilation on hospital admission.