期刊
JOURNAL OF INFECTION
卷 73, 期 4, 页码 314-325出版社
W B SAUNDERS CO LTD
DOI: 10.1016/j.jinf.2016.07.001
关键词
Bacterial pneumonia; Anti-infective agents; Drug resistance
资金
- Grants for Research on Policy Planning and Evaluation from Ministry of Health, Labour and Welfare, Japan [H27-Policy-Designated-009, H27-Policy-Strategy-011]
Objectives: To compare mortality between de-escalation and continued empirical treatment in patients with community-acquired pneumonia. Methods: Using a nationwide administrative database, we identified adult patients with community-acquired pneumonia caused by Streptococcus pneumoniae, other streptococci, Haemophilus influenzae, Klebsiella pneumoniae, or Escherichia coli (n = 10,231) or of unknown etiology (n = 8247), discharged between July 2010 and March 2013. De-escalation was determined by the spectrum and number of antimicrobials at day 4. We used propensity score matching to obtain 489 pairs of de-escalation and continuation groups among pathogen-identified patients and 278 pairs among culture-negative patients to compare mortalities. Results: In the pathogen-identified patients, de-escalation was noninferior to continuation in 15-day mortality [5.3% in de-escalation versus 4.3% in continuation, a difference of 1.0% (95% confidence interval, -1.7% to 3.7%)] and in-hospital mortality [8.0% in de-escalation versus 8.8% in continuation, a difference of -0.8% (95% confidence interval, -4.3% to 2.7%)]. In the culture-negative cases, de-escalation was noninferior to continuation in terms of 15-day mortality but not in terms of in-hospital mortality. Conclusions: Among patients with community-acquired pneumonia of specific etiology, de-escalation was noninferior to continuation of empirical treatment, suggesting that de-escalation is a safe strategy and supporting current recommendations. Safety of de-escalation in culture-negative cases is questionable. (C) 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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