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Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study.

挪威青霉素g/V 经验性处方降低社区获得性肺炎住院患者再入院风险: 一项回顾性观察性研究。

  • 影响因子:2.40
  • DOI:10.1186/s12890-020-01188-6
  • 作者列表:"Høgli JU","Garcia BH","Svendsen K","Skogen V","Småbrekke L
  • 发表时间:2020-06-15
Abstract

BACKGROUND:Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration. METHODS:We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression. RESULTS:We included 651 patients. Median age was 77 years [IQR; 64-84] and 46.5% were female. Median LOS was 4 days [IQR; 3-6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08-3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2-5] and 11.0 [IQR; 9.8-13] days. CONCLUSIONS:Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations.

摘要

背景: 挪威指南关于社区获得性肺炎 (CAP) 住院患者一线经验性抗生素处方的建议是单药治疗中的青霉素g/V,或青霉素g 联合庆大霉素 (或头孢噻肟) 治疗重症患者。本研究的目的是探讨不同的经验性抗生素治疗对住院时间 (LOS) 和 30 天再入院的影响。次要目的是描述静脉和总治疗持续时间的中位数。 方法: 我们纳入了 2010 年至 2012 年期间在挪威北部住院的 CAP 患者 (≥ 18 岁) 的回顾性研究。排除胸片阴性、恶性肿瘤或免疫抑制或频繁再入院的患者。我们从电子患者记录和医院管理系统中收集了患者特征、经验性抗生素处方、治疗持续时间和临床结局的数据。我们使用有向无环图进行统计模型选择,并用多变量 logistic 和线性回归分析数据。 结果: 我们纳入了 651 例患者。中位年龄为 77 岁 [IQR; 64-84],46.5% 为女性。中位 LOS 为 4 天 [IQR; 3-6],30 天再入院率为 14.4%,30 天死亡率为 6.9%。青霉素g/V 在 51.5% 的患者单药治疗中经验性处方,青霉素g 和庆大霉素在 22.9% 的患者中联合使用,其他抗生素在 25.6% 的患者中使用。处方除青霉素 G/V 单药治疗外的其他抗生素与再入院风险增加相关 [OR 1.9,95% CI; 1.08-3.42]。经验性抗生素处方与 LOS 无关。静脉和总治疗持续时间中位数分别为 3.0 [IQR; 2-5] 和 11.0 [IQR; 9.8-13] 天。 结论: 我们的研究结果表明,住院非严重 CAP 患者单药治疗中使用青霉素g/V 的经验性处方,没有恶性肿瘤、免疫抑制和频繁再入院等复杂因素。与其他抗生素治疗相比,30 天再入院的风险较低。中位总治疗持续时间超过治疗建议。

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影响因子:3.94
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