さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Narrow-spectrum ß-lactam monotherapy in hospital treatment of community-acquired pneumonia: a register-based cohort study

2017年 4月 (Epub 2016年12月)  CMI に発表された、スウェーデンで行われた CAPに対する狭域スペクトルベータラクタム単剤治療のコホート研究

 

 PECO

 

P : Hospitalized patients ≥18 years with CAP who received initial NSBM or BSBM, with a severity score according to CRB-65≤2 (C=confusion, R=respiratory rate >30/min, B=systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg, 65= ≥65 years)

 

E : narrow-spectrum ß-lactam monotherapy (NSBM)

NSBM was defined as empirical monotherapy with either penicillin G or penicillin V

 

C : broad-spectrum ß-lactam monotherapy (BSBM)

BSBM was defined as empirical monotherapy with either a cephalosporin or piperacillin/tazobactam.

 

O : No significant differences in 30-day mortality were observed between NSBM and BSBM in patients with CRB-65≤1 or CRB-65=2, OR 1.41 (95% CI 0.94-2.14) and 0.88 (95% CI 0.59-1.32), respectively.

 

 

Fig and Tab

 

f:id:akinohanayuki:20170630054207p:plain

f:id:akinohanayuki:20170630055112p:plain

 

f:id:akinohanayuki:20170630055133p:plain

 

f:id:akinohanayuki:20170630054226p:plain

 

Strength

The strength of the study was the large number of patients from most regions of Sweden, and the complete data of outcome and exposure resulting from the accurate Swedish inpatient and death registers.

 

Limitations

The estimated inclusion rate of 50 - 60% and lack of data on non-included patients is a limitation in terms of generalizability; however, for most characteristics the study population was similar to those in other pneumonia studies. We did not have data on sociodemographic status, alcohol habits, smoking, and time until administration of antibiotics, which have been associated with CAP, aetiology, and outcome [27e30]. Moreover, we cannot exclude some residual or unmeasured confounding under- estimating the relative effect of BSBM versus NSBM.

 

First Discussion

In this large national retrospective register-based cohort study of patients hospitalized with CAP, we compared outcomes with regard to different initial antibiotic regimens.

Our data suggest that BSBM is not more effective than NSBM as empirical treatment in patients with CRB-65 score 1 and also likely not in the majority of patients with a CRB-65 score of 2.

 

感想

CURB65が1-2で、ICU入院でなければ、ペニシリンGでトライできうる。

CURB65が2の方が、関係ないという結果も興味深い。

日本においても、研究が求められるが、CURB65の認識がそもそも薄い気がする....