Impact of Initial Antibiotic Choice on Clinical Outcomes of Community-Acquired Pneumonia in Adults

經驗性抗生素的選擇對成人社區型肺炎臨床結果之影響

林泰綜(Tai-Jung Lin) ； 郭英調(Benjamin Lng-Tiau Kuo) ； 吳綺華(Chi-Hua Wu) ； 吳傑亮(Chieh-Liang Wu) ； 金佩玲(Shiang-Ling King) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 19卷6期 (2004/12) Pp. 436-444

https://doi.org/10.29806/TM.200412.0003

摘要

前言：足夠與立即的經驗性抗生素治療可改善社區型肺炎的臨床結果。於中央健保局對抗生素使用的規範下，我們有與趣趣暸解經驗性抗生素的選擇對社區型肺肺炎臨床影響。
方法:我們回溯性地納入於西元2002年一年中住院於臺中榮民總醫院之輕度到中度(Fine risk class II, III and IV)社區型肺炎的病患。我們以住院總費用、住院天數及在院存活率(in-hospital survival rate)評估臨床結果的參數雲比較使用第一線抗生素與第二線抗生素者之間的臨床結果。
結果：總共一百一十六社區性肺炎病患收案。與使用第一線抗生素群比較後發現使用第二抗生素群有較長之住院天數(Mann-Whitney U test, p=0.008)與較高之住院總費用(Mann-Whitney U test, U test, p=0.0008)但是存活率無差別(Log-rank test; p=0.662)。
結論：使用第二線抗生素的患者無法證實有較佳的臨床結果，這可能導因於二組間疾病嚴重度的差異。

關鍵字

社區型肺炎 ； 抗生素 ； 花費一效益

並列摘要

Background: Adequate and immediate empiric antibiotic treatment improves the outcome of community-acquired pneumonia (CAP). Using the antibiotic regulation guidelines of the Bureau of National Health Insurance, we examined the impact of initial antibiotic choice on the outcome of CAP.
Methods and patients: In this study, we retrospectively reviewed patients with CAP (modified Fine risk classes II, Ill and IV) who were hospitalized in Taichung Veterans General Hospital in 2002. We assessed the outcome parameters, including total hospital costs, length of hospital stay (LOS), and in-hospital survival rate. We compared the outcome parameters of 2 groups:
the line antibiotics (1(superscript st) ATB) group and the 2(superscript nd) line antibiotics (2(superscript nd) ATB) group.
Results: A total of 116 patients were enrolled in the study. Compared to the 1(superscript st) ATB group, the 2(superscript nd) ATB group had a longer length of stay (Mann-Whitney U test, p=0.008) and higher hospital costs (Mann-Whitney U test, p=0.0004), but no significant difference in survival rate (log-rank test, p=0.662).
Conclusion: The 2(superscript nd) ATB group did not demonstrate a better outcome. This was probably due to the difference in disease severity.

並列關鍵字

community-acquired pneumonia ； antibiotic ； cost-effectiveness