Retrospective Analysis Of The Reasonable Treatment Of Community-acquired Pneumonia

Objective To explore the current therapeutic strategy for community acquired pneumonia(CAP)in the second affiliated hospital of Kunming Medical University,and to illuminate the reasonable therapeutic strategy for CAP.Methods The data of 417 hospitalized CAP patients from January 1 st,2002 to December 31,2006 was documented retrospectively.The patient's situation was scored by either Chinese CAP guideline or Fine's risk classification.The data was analyzed with SPSS 13.0 to identify the patients' hospital situation,the choice of the first dose antibiotics,the positive rate of sputum culture and the mortality,to explore the therapeutic conditions in the department,and in further,to explore the implementation of the Chinese CAP guideline in the department.Results 1(1)According to Chinese CAP guideline,80.6%of the 417 hospitalized CAP patients met the standard and 19.4%didn't meet the standard.There was no significant statistical difference between Chinese CAP guideline and Fine's risk classification(P=0.094).(2)The rate of hospitalization that met the Chinese CAP guideline had no significant statistical difference(P=0.473)in these five years.2(1)The average day of length of stay was(15±10),and there was no significant difference between ours and Xue Xiaoyan'(F=5.02,P＞0.05).(2)The average length of stay did not change obviously in the five years(F=1.958,P=0.1).3 The positive rate of sputum culture was 12.8%.Streptococcus pneumoniae was the most common causative organism,the percentage was 47%.4(1)From the year 2002 to 2006,all the first dose antibiotic treatment was administered within four hours except two.(2)In all the first dose antibiotics,theβ-lactam antibiotics ranked first(64.8%),followed by quinolones(17.3%),Lincomycin category(8.6%),macrolides(5.0%).In combination, Cephalosporin drugs combined with other types of antibiotics ranked first(92.3%).(3) The percentage that the first dose antibiotics used follow the Chinese CAP guideline was 68.8%(287/417).There was no significant difference in the percentage in five years(P=0.577).(4)The first dose antibiotic treatment was failed in 87 cases(20.86%), and among all the first dose antibiotics that were used in these 87 cases,β-lactam antibiotics accounted for 79.31%.①The treatment failure rate was the highest when the first dose antibiotic was cephalosporins plus quinolones,and followed byβ-lactams, cephalosporins plus macrolides,lincomycin,quinolones,macrolides.Through chi square test,P=0.064,it meaned that there was no difference among the various types of antibiotic in the treatment failure rate.②In 87 cases,the cases that the first dose antibiotics didn't follow the Chinese CAP guideline was 37,50 cases followed.Among the 50 cases,the reason was unknown in 14 cases,the remaining 36 cases were related with the severity of the illnesses,age≥65y and atypical pathogens seen in the sputum culture.③There was no significant difference among the failure rate of the first dose antibiotic treatment(P=0.913).(5)The death cases was 39,and among all the first dose antibiotics that were used in these 39 cases,β-lactam antibiotics was the most common.①The mortality was the lowest when the first dose antibiotic treatment used quinolones.②The mortality was 9.4%(39/417)in five years,and there was no significant difference in mortality in five years(P=0.624).③The mortality was 4.9%(14/287)when the first dose antibiotics used follow the Chinese CAP guideline, and the mortality was 19.2%(25/130)when didn't,the latter was obviously higher than the former(P=0.000).Conclusions 1 According to Chinese CAP guideline and PSI standards,some patients(19.42%～30.0%)could be safely treated as out-patients,and this condition results in the waste of medical resources.2 The positive rate of sputum culture was 12.8%,Streptococcus pneumoniae and Haemophilus influenzae were the common pathogens.Though the positive rate was lower than other regions in China,but the distribution of bacteria was similar with the other regions.Atypical pathogens antibody testing need to be undertaken.3 The average day of length of stay was(15±10),and it was similar with other reports in domestic.4 In all the first dose antibiotics, theβ-lactam antibiotics ranked first,followed by quinolones.In combination, Cephalosporin drugs combined with quinolones ranked first.5 The percentage that the first dose antibiotics used follow the Chinese CAP guideline was 68.8%(287/417).The first dose antibiotic treatment failure rate was 20.86%(87/287),and the failure rate was 17.42%(50/287)when the first dose antibiotics used follow the Chinese CAP guideline, and the failure rate was 28.46%(37/130)when didn't,through chi square test,P=0.013, it meaned that the first dose antibiotics used follow the Chinese CAP guideline can reduce the treatment failure rate.6 The mortality was 9.4%(39/417)in five years,and it it was similar with other reports.The mortality was 4.9%(14/287)when the first dose antibiotics used follow Chinese CAP guideline,and the mortality was 19.2%(25/130) when didn't,through chi square test,P=0.000,it meaned that the first dose antibiotics used follow the Chinese CAP guideline can reduce the mortality.7 No significant influence by the Chinese CAP guidelines on the therapy(the site,the length of stay,the mortality,the choice of the first dose antibiotics and its therapeutic conditions)of the CAP patients.Therefore,in order to raise the level of CAP therapy,the consciousness of strictly obey the Chinese CAP guideline for the management of CAP should be strengthened.