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. Another face is an investor.

Prophylactic Antimicrobial Therapy for Acute Aspiration Pneumonitis

CIDに報告された、誤嚥性肺炎に対する予防抗菌薬について。

 

academic.oup.com

 

感想

  • やはり、予防抗菌薬はよくなそう。1施設レトロ解析ですが。
  • Prophylactic antimicrobial therapy for patients with acute aspiration pneumonitis does not offer clinical benefit and may generate antibiotic selective pressures that results in the need for escalation of antibiotic therapy among those who develop aspiration pneumonia.

note

  • The primary outcome was in-hospital mortality within 30 days.
  • Secondary outcomes included transfer to critical care and antimicrobial therapy received between days 3 and 14 following macroaspiration including escalation of therapy and antibiotic-free days.
  • single-center retrospective cohort study

 

Abstract

Background

Prophylactic antimicrobial therapy is frequently prescribed for acute aspiration pneumonitis, with the intent of preventing the development of aspiration pneumonia. However, few clinical studies have examined the benefits and harms of this practice.

Methods

A retrospective cohort study design was used to compare outcomes of patients with aspiration pneumonitis who received prophylactic antimicrobial therapy with those managed with supportive care only during the initial 2 days following macroaspiration. The primary outcome was in-hospital mortality within 30 days. Secondary outcomes included transfer to critical care and antimicrobial therapy received between days 3 and 14 following macroaspiration including escalation of therapy and antibiotic-free days.

Results

Among 1483 patients reviewed, 200 met the case definition for acute aspiration pneumonitis, including 76 (38%) who received prophylactic antimicrobial therapy and 124 (62%) who received supportive management only. After adjusting for patient-level predictors, antimicrobial prophylaxis was not associated with any improvement in mortality (odds ratio, 0.9; 95% confidence interval [CI], 0.4–1.7; P = .7). Patients receiving prophylactic antimicrobial therapy were no less likely to require transfer to critical care (5% vs 6%; P = .7) and subsequently received more frequent escalation of antibiotic therapy (8% vs 1%; P = .002) and fewer antibiotic-free days (7.5 vs 10.9; P < .0001).

Conclusions

Prophylactic antimicrobial therapy for patients with acute aspiration pneumonitis does not offer clinical benefit and may generate antibiotic selective pressures that results in the need for escalation of antibiotic therapy among those who develop aspiration pneumonia.

 

Prophylactic Antimicrobial Exposure

Patient antimicrobial exposures were extracted from the Stewardship Program Integrating Resource Information Technology database, which contains all hospital antimicrobial prescriptions at Sunnybrook Health Sciences Centre [10]. For study purposes, we defined prophylactic antimicrobial exposure as receipt of any antimicrobial agent that would provide coverage for respiratory bacterial pathogens newly initiated within the acute aspiration pneumonitis time window, including piperacillin/tazobactam, ertapenem, meropenem, ceftriaxone, moxifloxacin, levofloxacin, amoxicillin/clavulanate, and cefuroxime. This time window was defined as the initial 2 days following the documented macroaspiration. Patients who did not receive any of the aforementioned antibiotics within 2 days of the acute macroaspiration event were considered not to have received antimicrobial prophylaxis and classified as managed with supportive care only.

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