• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Antibiotics >Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infections
【24h】

Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infections

机译：降钙素引导的抗生素治疗下呼吸道感染的疗效和安全性

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background: In 14 randomized controlled studies to date, a procalcitonin (PCT)-based algorithm has been proven to markedly reduce the use of antibiotics along with an unimpaired high safety and low complication rates in patients with lower respiratory tract infections (LRTIs). However, compliance with the algorithm and safety out of controlled study conditions has not yet been sufficiently investigated. Methods: We performed a prospective international multicenter observational post-study surveillance of consecutive adults with community-acquired LRTI in 14 centers (Switzerland (n = 10), France (n = 3) and the United States (n = 1)). Results: Between September 2009 and November 2010, 1,759 patients were enrolled (median age 71; female sex 44.4%). 1,520 (86.4%) patients had a final diagnosis of LRTI (community-acquired pneumonia (CAP), 53.7%; acute exacerbation of chronic obstructive pulmonary disease (AECOPD), 17.1%; and acute bronchitis, 14.4%). Compliance with the PCT-guided therapy (overall 68.2%) was highest in patients with bronchitis (81.0% vs. AECOPD, 70.1%; CAP, 63.7%; p 0.001), outpatients (86.1% vs. inpatients, 65.9%; p 0.001) and algorithm-experienced centers (82.5% vs. algorithm-naive, 60.1%; p 0.001) and showed significant geographical differences. The initial decision about the antibiotic therapy was based on PCT value in 72.4%. In another 8.6% of patients, antibiotics were administered despite low PCT values but according to predefined criteria. Thus, the algorithm was followed in 81.0% of patients. In a multivariable Cox hazard ratio model, longer antibiotic therapy duration was associated with algorithm-non-compliance, country, hospitalization, CAP vs. bronchitis, renal failure and algorithm-naïvety of the study center. In a multivariable logistic regression complications (death, empyema, ICU treatment, mechanical ventilation, relapse, and antibiotic-associated side effects) were significantly associated with increasing CURB65-Score, CAP vs. bronchitis, multilobar pneumonia, but not with algorithm-compliance. Discussion: Cultural and geographic differences in antibiotic prescribing affected the compliance with our PCT-guided algorithm. Efforts to reinforce compliance are needed. Antibiotic stewardship with PCT is possible, effective and safe without increasing the risk of complications in real-life conditions.
机译：背景：迄今为止，在14项随机对照研究中，基于降钙素（PCT）的算法已被证明可显着减少下呼吸道感染（LRTIs）患者的抗生素使用以及高安全性和低并发症发生率。但是，尚未充分研究对算法的遵循性和不受控制的研究条件的安全性。方法：我们对14个中心（瑞士（n = 10），法国（n = 3）和美国（n = 1））社区获得性LRTI的连续成人进行了前瞻性国际多中心观察性研究后监测。结果：2009年9月至2010年11月，招募了1759例患者（中位年龄71岁;女性44.4％）。 1,520名患者（86.4％）对LRTI进行了最终诊断（社区获得性肺炎（CAP）为53.7％;慢性阻塞性肺疾病的急性加重（AECOPD）为17.1％;急性支气管炎为14.4％）。支气管炎患者对PCT指导疗法的依从性（总68.2％）最高（81.0％vs. AECOPD，70.1％; CAP，63.7％; p <0.001），门诊患者（86.1％vs.住院患者，65.9％; p <0.001）和具有算法经验的中心（82.5％与未使用算法的中心，60.1％; p <0.001），并且显示出显着的地理差异。关于抗生素治疗的最初决定是基于72.4％的PCT值。在另外8.6％的患者中，尽管PCT值较低，但仍按照预定标准进行了抗生素治疗。因此，在81.0％的患者中遵循了该算法。在多变量Cox风险比模型中，较长的抗生素治疗持续时间与研究中心的算法不依从，国家/地区，住院，CAP与支气管炎，肾衰竭和算法不成熟相关。在多变量logistic回归分析中，并发症（死亡，脓胸，ICU治疗，机械通气，复发和抗生素相关的副作用）与CURB65评分升高，CAP与支气管炎，多叶性肺炎显着相关，但与算法依从性无关。讨论：抗生素处方的文化和地理差异影响了我们PCT指导算法的依从性。需要加强合规性的努力。 PCT的抗生素管理是可能的，有效的和安全的，而不会增加现实生活中发生并发症的风险。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号