| Objective To investigate the antibiotics treatment situation and choose of antibiotics following guideline for the patients with community-acquired pneumonia(CAP) in Tianjin region. Then understand the present situation of diagnosis and treatment of CAP in Tianjin and observe the factors associated with early treatment failure, so as to provide reference for the clinical basis.Method From March2010to February2012,668hospitalized adults with confirmed diagnosis of CAP collected from10hospitals in Tianjin was investigated.The diagnosis of CAP was performed according to the following criteria based on Chinese CAP guidelines published in2006.The baseline characteristics and clinical parameters were collected by report card.To compare the chooses of the antibiotics used pre-admission and inhospital and analysis the conditions of antibiotics abided by CAP guidelines.To monitor the body temperature,heart rate,respiratory frequency and saturation of blood oxygen during the therapy.The patients used antibiotics72hours and could not reach the stability were defined early treatment failure.The191patients outcame early treatment failure was defined nonresponse group and the others were classified response group. All the statistical analysis was performed using SPSS version19.0.The categorical data were expressed as percentages and were compared using a chi-square test. The numeric data were expressed as(x±s). Multiple Logistic regression analysis was used to determine independent risk factors for early treatment failure. To determine risk factors associated with early treatment failure in patients with CAP.AP value less than0.05was considered to be statistically significant.Result1.A total of668patients with CAP were included in our study, in which the mean age of the sample cohort was (57±22)years,and363were male when305were female.Almost55.5%of the patients (371/668) had at least one of the following disease:heart,or cerebrovascular disease, diabetes mellitus, chronic lung diseases, and so on.Among210patients had one co-morbidity,131patents had two co-morbidities and30ones had three or more diseases. Of the total, almost45.8%of the patients (306/668) were age≥65years, almost78.3%of the patents (523/668) were CRB-65score≥1.Among of the total191patients (about28.6%)came out early treatment failure. During the hospital time,14patients died of multi-organ function failure.2.Prior to admission about63.6%of the patients(425/668) had used antibiotics.In turn,the proportions of the four common antibiotics were:Penicillin or1/2-generation cephalosporin antibiotics(18.6%),β-lactam and macrolide antibiotics (16.0%),fluoroquinolonel antibiotics(14.4%),macrolide monotherapy (11.5%).All the patients were treated with antibiotics treatment after admission.Almost25.7%of the patients were treated with fluoroquinolonel antibiotics,24.4%of the patients were used (3-lactam and fluoroquinolonel,16.0%of them were treated with β-lactam with enzyme inhibitors when13.0%patients used β-lactam and macrolide antibiotics.The percentage of following guideline to choose antibiotics in pre-admission was higher than the inhospital and there was a significant difference between them (P<0.05)3.As compared to those of non-early treatment failure,age>65years,CRB-65scores concomitant diabetes mellitus or chronic lung diseases, basic diseases species>2,choosed antibiotics abided by guideline, treated with antibiotics before admission and lesions in multilobar or bilateral lungs were more frequently seen in patients with early treatment failure. Results of multivariate Logistic regression analysis indicated that risk factors independently associated with development of early treatment failure included age>65years, concomitant diabetes mellitus, concomitant chronic lung diseases and treated with antibiotics before admission (P<0.05)4.The mean time to clinical stability of nonresponse group was (4.3±1.6)d, when the response group was (1.5±1.0)d, there was a significant difference between them(P <0.01).The patients’ mean length of stay was (11.5±4.8)d in nonresponse group and was (10.9±4.9)d in response group, but there was no significant difference between them(P>0.05). The patients’ mean antibiotic cost is (4398.9±4422.4)Y in the early treatment failure group and (3800.0±3236.8)￥in the non-early treatment failure group, and there was a significant difference in the cost(P<0.05) but not in the hole cost(P>0.05).There was no significant difference in the mortality of the two groups(2.6%vs1.9%,P>0.05). Conclusions1Antibiotics used pre-admission and inhospital had a great difference, and part of chooses were unreasonable, but the situation of pre-admission was more serious. The chooses of antibiotics following the guidelines for inhospital patients were better than the pre-admission, but needed further specification.2The early treatment failure rate of CAP in Tianjin was similar to the domestic average level, but was still higher than the level of foreign.3The risk factors associated with the early treatment failure of CAP was complicated. For patients with risk factors, we must take it seriously and take measures preventive and corrective early. Thereby to improve the clinical efficacy in patients with CAP.4The early treatment failure of CAP prolonged the time to clinical stability and increased the antibiotics cost during the therapy. The sequential antibiotic therapy was needed to be further promotion in Tianjin region.5The study accounted for more elderly patients,there was a certain reference value for the clinical research of early treatment failure in the middle-aged and elderly population. |
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