Associated Influencing Factors And Rationality Of Antibiotic Use In Hospitalized Patients With AECOPD

Background:Chronic obstructive pulmonary disease(COPD)has become the third leading cause of death in the world,and its acute exacerbation stage significantly increases the mortality of patients.The first inducement of AECOPD in China is infection,and clinicians believe that the primary cause of infection is bacteria,so AECOPD patients will accept basically antibiotic treatment.In this context,the abuse rate of antibiotics and the drug resistance rate of bacteria have not received satisfactory results under the intervention of national policies.Objective:Through a retrospective analysis of the factors affecting the use of antibiotics and their rationality in AECOPD inpatients in a hospital,so as to provide a basis for the accurate use of antibiotics and reduce the use of unnecessary antibiotics.So as to make patients truly benefit from clinical treatment and alleviate the pressure of social public health and economy.Methods:This study is a retrospective cross-sectional study conducted in Nanfang Hospital of Southern Medical University.AECOPD patients admitted to Nanfang Hospital from January 2020 to August 2021 were continuously included.The inclusion criteria were:(1)patients with AECOPD after discharge;(2)AECOPD was diagnosed according to gold guideline standard(2021 Edition).The exclusion criteria were:Patients with other lesions found on chest plain radiographs;Patients with pulmonary fibrosis;Tuberculosis patients;Patients with immune deficiency or long-term use of immunosuppressants;Patients with malignant tumors;Patients with autoimmune diseases;Accompanied by other diseases requiring antibiotic treatment;Patients with severe hepatic and renal insufficiency;Recent or new pulmonary embolism or cerebrovascular accident;Patients with acute coronary syndrome;Incomplete data to be collected.The gender,age,smoking history,nature of sputum,length of hospital stay,total number of neutrophils,time and type of antibiotics of patients meeting the above criteria were collected through the hospital medical record system.SPSS 26.0 and graphpad prism 8.0.2 statistical software were used for relevant statistics.Measurements and results:A total of 127 patients were included,and 101 patients met the criteria above.① The median use time of antibiotics in patients with hospitalization time≤8 days was shorter and the types of antibiotics used were less than those in patients with hospitalization time>8 days.Smoking and the nature of sputum had no significant effect on the use of antibiotics.The median use time of antibiotics in patients with total number of neutrophils≤6.3 × 109/L was shorter than that in patients with>6.3 × 109/L;The former uses fewer kinds of antibiotics than the latter.hs-CRP had no significant effect on the use time of antibiotics;The kinds of antibiotics used in patients with hs-CRP≤6mg/L were less than those with hs-CRP>6mg/L.The time of use antibiotics in patients with Proct≤0.05ng/ml was shorter than that in patients with Proct>0.05ng/ml;The former uses fewer kinds of antibiotics than the latter.There was no significant difference in the use time of antibiotics among the four groups of GOLD grade;The kinds of antibiotics of four groups are not completely same.② Univariate linear regression analysis showed a linear relationship with the duration of antibiotic use:length of stay,neutrophil count,FEV1%PRED;The factors that had linear regression relationship with the type of antibiotics were:length of stay,hs-CRP and FEV1%PRED.③ The factors that had significant influence on the duration of antibiotic use by multi-factor stepwise linear regression analysis were:length of stay;The factors that had significant influence on the kinds of antibiotic use were length of stay,FEV1%PRED and sputum properties.Conclusion:This study found that almost all hospitalized patients with AECOPD in our center received antibiotic treatment,but objectively speaking,there is not such a high proportion of bacterial infection in the inducement of AECOPD,which not only damages the economic benefits,but also increases the rate of antibiotic resistance.Single factor grouping comparison shows that the nature of sputum does not affect the use of antibiotics,which is inconsistent with the recommendations of GOLD guidelines for the use of antibiotics.hs-CRP only affects the types of antibiotics.Although ProCT has an impact on the time and types of antibiotics,hs-CRP is more common and more economic.And from the results of multi factor stepwise regression analysis with comprehensive analysis effect,only the length of hospital-stay affects the time of antibiotic use,which is lack of objective symptoms and index evidence support.To sum up,the doctors in our center are unreasonable in the use of antibiotics in patients with AECOPD.The use of objective indicators or symptoms to make the use of antibiotics more reasonable needs to be further implemented.