Analysis Of Initial Antimicrobial Treatment And Early Treatment Failure With Community-acquired Pneumonia In Tianjin

ObjectiveTo research and study the application of the initial antimicrobial agents with community acquired pneumonia in Tianjin. Further to learn about the implementation of the CAP guide line in Tianjin. To investigate the correlation factor that impact initial treatment failure of CAPMethodsIn this study, patients with CAP admitted to10hospitals in Tianjin, from March2010to June2011are our object. Make Record the following data: the number of cases, age, Sex, body temperature, mental status, appetite, severity score (CURB-65), concomitant diseases, whether hormones, immunosuppressant, radiotherapy and chemotherapy, clinical symptoms/signs, laboratory and imaging findings, and initial antimicrobial medicine. Retrospective study analyzed the CAP initial treatment and the correlation factor of initial treatment failure.Results1This study included701patients with CAP,6patients were excluded (2cases eventually proved to tuberculosis,4cases with incomplete data). male,375cases, female326cases; Age14-98years old, average age (57.7±22.53).2During the701patients,431cases complicated with basic diseases,270cases with no basic diseases. The common basis diseases of CAP patients:coronary heart disease, high blood pressure, cerebrovascular disease, diabetes, COPD, asthma, tumor, connective tissue diseases, etc.3In this study, a total of634cases received the CURB-65score,427cases’ score≥2,207cases’score≤l,the study had shown that67.4%of the inpatients accord with hospital standards.4583cases received antimicrobial drugs in the initial treatment,118cases without antimicrobial drug. The selective proportion of antibacterial drugs shows as follows:β-lactams(27.6%),levofloxacin(15%),macrolides(14.5%),moxifloxacin (13.7%),β-lactams+fluoroquinolones (8.2%), β-lactams+macrolides (9.8%), β-lactam+aminoglycoside (3.4%), others (7.8%). 5During583cases, the application of antibacterial agent in the initial treatment487cases follow the CAP guidelines.96cases do not meet the guideline:44patients is unreasonable,34cases usage and dosage is unreasonable, the combination medication of18cases is unreasonable.6The results of this study showed that117cases of initial treatment was failure, the rate of initial treatment failure was25%7The study showed the related factors of the failure rate at the initial antibiotic therapy:treatment comply with the guidelines or not, the CURB-65score, age, or disease diabetes, COPD. And gender, hypertension, coronary heart disease with no correlationConclusions1The choice of antibiotic for the initial treatment of CAP patients is complex, some do not meet guidelines, and need to further specification; beta-lactam drugs are the mainly antimicrobial agents, next are quinolones, the proportion of monotherapy is higher compared with combination.2In Tianjin the failure rate of the initial treatment on CAP patients is about similar as the domestic report, but still higher than the level of foreign3Whether the CAP treatment follow the guidelines had a significant effect on the initial treatment failure rate, therefore, being aware of follows the CAP guidelines is needed to improve the level of CAP treatment.4The initial antimicrobial treatment failure rate is related with treatment complied with the guideline or not, CURB-65score, age, diabetes, COPD, but not related with gender, hypertension, coronary heart disease.