{"id":25282,"date":"2024-02-04T04:20:00","date_gmt":"2024-02-03T20:20:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25282"},"modified":"2024-02-04T05:47:02","modified_gmt":"2024-02-03T21:47:02","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e4%b8%80%e7%ba%bf%e6%88%96%e6%9b%bf%e4%bb%a3%e6%8a%97%e7%94%9f%e7%b4%a0%e6%96%b9%e6%a1%88%e5%af%b9%e9%9d%9e%e9%87%8d%e7%97%87%e7%a4%be%e5%8c%ba","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25282","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u4e00\u7ebf\u6216\u66ff\u4ee3\u6297\u751f\u7d20\u65b9\u6848\u5bf9\u975e\u91cd\u75c7\u793e\u533a\u83b7\u5f97\u6027\u80ba\u708e\u4f4f\u9662\u60a3\u8005\u7684\u7597\u6548\u6bd4\u8f83"},"content":{"rendered":"\n

CHEST INFECTIONS: ORIGINAL RESEARCH|\u00a0VOLUME 165, ISSUE 1<\/a>,\u00a0P68-78,\u00a0JANUARY 2024<\/p>\n\n\n\n

Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study<\/h1>\n\n\n\n

Anthony D. Bai, Siddhartha Srivastava, Benjamin K.C. Wong, et al<\/h3>\n\n\n\n

Chest 2024; 165: 68-78 Published: August 10, 2023<\/h3>\n\n\n\n

DOI: https:\/\/doi.org\/10.1016\/j.chest.2023.08.008<\/a><\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

There are several antibiotic regimens to treat community-acquired pneumonia (CAP).<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

In patients hospitalized to a non-ICU ward setting with CAP, is there a difference between first-line and alternative antibiotic regimens (\u03b2-lactam plus macrolide [BL+M], \u03b2-lactam [BL] alone, respiratory fluoroquinolone [FQ], or \u03b2-lactam plus doxycycline [BL+D]) in terms of in-hospital mortality?<\/p>\n\n\n\n

Study Design and Methods<\/h3>\n\n\n\n

This retrospective cohort study included consecutive patients admitted with CAP at 19 Canadian hospitals from 2015 to 2021. Taking a target trial approach, patients were categorized into the four antibiotic groups based on the initial antibiotic treatment within 48 h of admission. Patients with severe CAP requiring ICU admission in the first 48 h were excluded. The primary outcome was all-cause in-hospital mortality. Secondary outcome included time to being discharged alive. Propensity score and overlap weighting were used to balance covariates.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

Of 23,512 patients, 9,340 patients (39.7%) received BL+M, 9,146 (38.9%) received BL, 4,510 (19.2%) received FQ, and 516 (2.2%) received BL+D. The number of in-hospital deaths was 703 (7.5%) for the BL+M group, 888 (9.7%) for the BL group, 302 (6.7%) for the FQ group, and 31 (6.0%) for the BL+D group. The adjusted risk difference for in-hospital mortality when compared with BL+M was 1.5%\u00a0(95%\u00a0CI,\u00a0\u22120.3%\u00a0to 3.3%) for BL,\u00a0\u22120.9%\u00a0(95%\u00a0CI,\u00a0\u22122.9%\u00a0to 1.1%) for FQ, and\u00a0\u22121.9%\u00a0(95%\u00a0CI,\u00a0\u22124.8%\u00a0to 0.9%) for BL+D. Compared with BL+M, the subdistribution hazard ratio for being discharged alive was 0.90 (95%\u00a0CI, 0.84-0.96) for BL, 1.07 (95%\u00a0CI, 0.99-1.16) for FQ, and 1.04 (95%\u00a0CI, 0.93-1.17) for BL+D.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

BL+M, FQ, and BL+D had similar outcomes and can be considered effective regimens for nonsevere CAP. Compared with BL+M, BL was associated with longer time to discharge and the CI for mortality cannot exclude a small but clinically important increase in risk.<\/p>\n","protected":false},"excerpt":{"rendered":"

CHEST INFECTIONS: ORIGINAL RESEARCH|\u00a0VOLUME 165, ISSUE […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25282"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25282"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25282\/revisions"}],"predecessor-version":[{"id":25283,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25282\/revisions\/25283"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25282"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25282"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25282"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}