据5月26日刊JAMA上的一则研究披露，在因慢性阻塞性肺病（COPD）急性恶化而住院治疗的患者中，与那些接受抗菌素治疗较晚或完全没有接受抗菌素的人相比，那些在入院后头2天中接受了抗菌素的患者的结果会有所改善，其中包括他们上呼吸机的可能性较低且再次入院治疗的可能性也较低。
COPD是美国排第四位的主要死亡原因，至少有1200万的美国人受到该疾病的影响。文章的作者写道：“COPD的急性恶化与每年超过60万例的住院有关，其所造成的直接费用超过200亿美元。有关的治疗方针建议对COPD的急性恶化给予抗菌素的治疗，但这一建议所循的证据是基于小型、异源性的试验，其中较少有试验包括了住院的患者。”
Baystate Medical Center, Springfield, Mass.的Michael B. Rothberg, M.D., M.P.H.及其同僚对在抗菌素的使用和因COPD的急性恶化而住院的患者的后果之间的关系进行了检查，这些患者来自全美国413个急性护理机构，时间是2006年1月至2007年12月。在所分析的主要结果中包括了一个对治疗失败的复合测定，治疗失败被定义为入院的第二天就开始使用呼吸机、住院时死亡或在出院后的30天内因为COPD的急性加剧而重新入院；他们还对患者住院时间的长度和住院的费用进行了检查。
在8万4621名患者中，有79%的人接受了至少连续2天的抗菌素治疗。研究人员发现，与那些在入院头2天没有接受抗菌素治疗的患者相比， 这些接受了抗菌素治疗的病人在入院的第二天后上呼吸机的可能性较小（1.07% vs. 1.80%）、住院 时死亡率较低(1.04% vs. 1.59%)、治疗失败率较低（9.77% vs. 11.75%）以及因为COPD的急性恶化而重新入院的比率较低 （7.91% vs. 8.79%）。接受或没有接受抗菌素治疗的病人的住院时间的长短相似，但接受了抗菌素治疗的患者的治疗成本较低。
与没有接受抗菌素治疗的患者相比，那些接受了抗菌素制剂的患者因为难辨梭状芽孢杆菌的感染而再次入院的比例较高。在经过进一步的分析之后，在接受了抗菌素治疗的患者中其发生治疗失败的风险要较低。文章的作者写道：“根据治疗失败风险而进行的层级分析发现，在所有的亚组病人中，都存在着类似程度的裨益。”
文章的作者得出结论：“…在获得更多的数据之前，对COPD的急性恶化患者常规使用抗菌素可能是适当的。”(生物谷Bioon.com)
生物谷推荐原文出处：
JAMA. 2010;303(20):2035-2042.
Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease
Michael B. Rothberg, MD, MPH; Penelope S. Pekow, PhD; Maureen Lahti, MBBS, MPH; Oren Brody, MD; Daniel J. Skiest, MD; Peter K. Lindenauer, MD, MSc
Context Guidelines recommend antibiotic therapy for acute exacerbations of chronic obstructive pulmonary disease (COPD), but the evidence is based on small, heterogeneous trials, few of which include hospitalized patients.
Objective To compare the outcomes of patients treated with antibiotics in the first 2 hospital days with those treated later or not at all.
Design, Setting, and Patients Retrospective cohort of patients aged 40 years or older who were hospitalized from January 1, 2006, through December 31, 2007, for acute exacerbations of COPD at 413 acute care facilities throughout the United States.
Main Outcome Measures A composite measure of treatment failure, defined as the initiation of mechanical ventilation after the second hospital day, inpatient mortality, or readmission for acute exacerbations of COPD within 30 days of discharge; length of stay, and hospital costs.
Results Of 84 621 patients, 79% received at least 2 consecutive days of antibiotic treatment. Treated patients were less likely than nontreated patients to receive mechanical ventilation after the second hospital day (1.07%; 95% confidence interval [CI], 1.06%-1.08% vs 1.80%; 95% CI, 1.78%-1.82%), had lower rates of inpatient mortality (1.04%; 95% CI, 1.03%-1.05% vs 1.59%; 95% CI, 1.57%-1.61%), and had lower rates of readmission for acute exacerbations of COPD (7.91%; 95% CI, 7.89%-7.94% vs 8.79%; 95% CI, 8.74%-8.83%). Patients treated with antibiotic agents had a higher rate of readmissions for Clostridium difficile (0.19%; 95% CI, 0.187%-0.193%) than those who were not treated (0.09%; 95% CI, 0.086%-0.094%). After multivariable adjustment, including the propensity for antibiotic treatment, the risk of treatment failure was lower in antibiotic-treated patients (odds ratio, 0.87; 95% CI, 0.82-0.92). A grouped treatment approach and hierarchical modeling to account for potential confounding of hospital effects yielded similar results. Analysis stratified by risk of treatment failure found similar magnitudes of benefit across all subgroups.
Conclusion Early antibiotic administration was associated with improved outcomes among patients hospitalized for acute exacerbations of COPD regardless of the risk of treatment failure.
