The Evaluation On Initial Primary Therapy Of Community Acquired Pneumonia And Clinical Stability Research In Tianjin

ObjectiveTo investigate if the 72 hour evaluation on initial primary therapy of community acquired pneumonia have effect on patients'consequence, time to clinical stability, length of stay, total cost and antibiotic cost. To research the time to clinical stability of community acquired pneumonia and its factors in Tianjin. To observe the choose of antibitics of initiate therapy and to compare its effect.MethodsBetween March of 2010 and April of 2011, the community acquired pneumonia patients who were hospitalized into 10 hospitals in Tianjin were enrolled randomly; The observation group were evaluation on zero hour and 72 hour, while the conventional group without these two evaluations, then comparing the effect, time to clinical stability, length of stay, total cost and antibiotic cost. Recording different type of antibiatics of initial primary therapy and its replacement, then compare the proportion of antibiatics, the proportion of replacement and its effect on time to clinical stability, length of stay, total cost and antibiotic cost. Recording patients'time to clinical stability and analysising the connection between age, gender, complications, duration of being favor, the use of antibiatic before being hospitalized, the vital signs when being hospitalized and time to clinical stability.Results1) Totally,410 patients were enrolled.6 patients were excluded. Finally,404 patients were statistically analysised, including 199 patients in observation group and 205 patients in conventional group. Between two groups, there is no statistical significant in the difference of effect, time to clinical stability, length of stay, total cost and antibiotic cost (P>0.05)2) In turn, the proportions of antibitic of initial primary therapy are:β-lactam mono-therapy (31.7%), Moxifloxacin monotherapy (22.1%),β-lactam and fluoroqui-nolone(18.3%),β-lactam and macrolide(14.7%), Levofloxacin monotherapy(5.3%),β-lactam and aminoglycoside(3.3%), macrolide monotherapy (3.0%) and others (1.5%); among these eight types, there is statistical significant in proportion of changement because of no effect (P<0.05); however, there is no statistical significant in the proportion of reaching clinical stability within 3 days, length of stay, total cost and antibiotic cost (P>0.05);3) Patient'mean time to clinical stability is 3.3 days; 66.1% patients reached clinical stability within 3 days and 93.4% patients within 7 days. The factors that connected to clinical stability are:age (OR,1.012; 95%CI,1.003-1.022), having complications (OR=,1.823; 95%CI,1.189-2.793),lesions (OR,2.013; 95%CI,1.310-3.094); other factors have no connections to time to clinical stability;4) Patients' mean length of stay is 11.4±5.3 days, mean cost is￥10524.7±￥7644.5, mean antibiotic cost is￥698.9±￥2533.7.Conclusions1) This research does not find the meaning of 0 hour evaluation and 72 hour evaluation in initial primary therapy of CAP;2) The antibiatic chooses of initiate therapy are complicated; but part of chooses are not comply with guidelines;3) Most patients reached clinical stability within 1 weak; however, if clinical stability could be the standard of switching from intravenous to oral therapy or discharging, more randomized controlled study are needed;4) The mean length of stay in Tianjin is less than the national average level, but is still higher than the level of foreign.