成人社区获得性肺炎患者住院时间的影响因素分析

目的综合分析影响成人社区获得性肺炎（CAP）患者平均住院时间的临床及非临床因素。方法回顾性分析2002年1月至2006年1月我院收治的成人CAP患者的临床资料,根据Fine危险分级标准分为低危组（Ⅰ～Ⅲ级）和高危组（Ⅳ～Ⅴ级）。分析2组住院时间延长者的影响因素。结果共计302例成人CAP患者人选。其中111例（36．8％）处于Fine危险分级Ⅰ～Ⅲ级,191例（63．2％）处于Ⅳ～Ⅴ级。总体住院时间2～47d,平均10．5d。Ⅰ～Ⅲ级的低危患者平均住院时间7．5d,Ⅳ～Ⅴ级高危患者为11．5d。肺炎相关因素和非临床因素导致住院时间延长的患者比例在低危组显著高于高危组（P〈0．05）。而出现并发症和基础疾病恶化导致住院时间延长的患者比例在高危组显著高于低危组（P〈0．05）。结论目前我国成人CAP患者的平均住院时间仍高于国外水平。除了稳定基础疾病和防治并发症外,必须捉商医疗服务质量,减少非临床因素导致的非必要住院时问。     

Comparison of hospitalization rates in patients with community-acquired pneumonia treated with 10 days of telithromycin or clarithromycin

SUMMARY

Aims: To compare the impact on hospitalization rates and the clinical efficacy of oral telithromycin and clarithromycin treatment in patients with community-acquired pneumonia (CAP).

Patients and methods: Outpatients aged >18 years (n?=?448) with CAP were enrolled in a randomized, double-blind, multinational study and received telithromycin 800?mg once daily (n?=?224) or clarithromycin 500?mg twice daily (n?=?224) for 10 days. The primary outcome measure was clinical efficacy at post-therapy/test of cure (Days 17–24) in the per-protocol population. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use were compared by treatment group (intent to treat population) up to the late post-therapy visit (Days 31-36). Study investigators who were blinded to the treatment arm assessed whether hospital admissions were CAP related or not. Hospitalization costs (US$) associated with telithromycin and clarithromycin treatment were compared.

Results: Per-protocol clinical cure rates for telithromycin and clarithromycin were statistically equivalent (88.3% [143/162] vs 88.5% [138/156] - difference: ?0.2%; 95% CI: ?7.8, 7.5). There were four CAP-related hospitalizations (1.8 events/100 patients) among patients treated with telithromycin vs eight (3.6 events/100 patients) among clarithromycin patients (p?=?0.281). The total number of CAP-related hospital days for telithromycin and clarithromycin patients was 23 vs 64 days (10.3 vs 28.6 days/100 patients), respectively (p?=?0.177). CAP-related hospitalization costs per 100 telithromycin and clarithromycin patients were $20360 vs $70567, respectively (difference: ?25182; 95% CI: ?49531; 9168).

Conclusions: This study demonstrates that telithromycin is an effective therapy for outpatients with CAP. There were no significant differences in hospitalization rates between treatments; however, a tendency towards a numerically reduced number of hospitalizations/days required in hospital among telithromycin patients was observed. This could potentially translate into reduced hospitalization costs for telithromycin vs clarithromycin in the treatment of CAP.     

Hospitalization rates among patients with community-acquired pneumonia treated with telithromycin vs clarithromycin: results from two randomized,double-blind,clinical trials

SUMMARY

Aims: To compare hospitalization rates among patients with community-acquired pneumonia (CAP) treated with oral telithromycin and clarithromycin, based on pooled data from two randomized, double-blind, multinational clinical trials.

Patients and methods: Adult patients with CAP eligible for oral therapy (Study 1, n = 448; Study 2, n = 575) received telithromycin 800?mg once daily for 10 (Study 1, 2-arms), 5 or 7 (Study 2, 3-arms) days, or clarithromycin 500?mg twice daily for 10?days. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use, as well as CAP-related length of hospital stay and hospitalization costs, were compared by treatment group (intent to treat populations) up until the late post-therapy visit (Days 31–36). Study investigators blinded to treatment regimen assessed whether hospital admissions were CAP related.

Results: Despite equivalent clinical efficacy for telithromycin vs clarithromycin in the clinically evaluable per-protocol populations (n = 784) (88.8% [428/482] vs 90.1% [272/302] – difference: –1.3%; 95% CI: –6.0, 3.4), telithromycin treatment for 5, 7, or 10?days was associated with significantly fewer CAP-related hospitalizations (?p = 0.023) and CAP-related hospital days (?p = 0.025) vs clarithromycin (reduction of 2.3 hospitalizations and 23.4 hospital days per 100 patients). Accordingly, estimated CAP-related hospitalization costs were significantly lower (?p = 0.025) for telithromycin recipients (US$30?231 less per 100 patients). CAP-related hospitalizations, duration of hospital stay, and hospitalization costs for 7- to 10-day telithromycin – the approved dosing regimen for CAP – were significantly lower (?p = 0.023, 0.025, and 0.025, respectively) than for clarithromycin.

Conclusions: Data from this study indicate that telithromycin 800?mg once daily for 5, 7, or 10?days provides an effective therapy for patients with CAP, and may be associated with fewer CAP-related hospitalizations and hospital days than clarithromycin 500?mg twice daily for 10?days. Treatment with telithromycin could, therefore, potentially translate into cost savings in the management of CAP.     

患者住院时间与医院感染发生的关系分析

目的探讨患者住院时间与医院感染发生的关系,并总结护理经验。方法选择本院2010年4月～2012年12月住院患者1800例的资料,其中发生医院感染32例,分析住院时间与医院感染发生的关系,并总结护理经验。结果医院感染组患者住院时间≥7d的比例为50.0%,而非医院感染组患者住院时间≥7d的比例为8.6%,两者差异有统计学意义（P〈0.05）,表明住院时间越长,发生医院感染的概率越大。所有医院感染患者经过对症处理后,均痊愈出院。结论患者住院时间与医院感染发生率存在正相关性,医院应科学合理地加强护理措施,以降低医院感染发生率。     

社区获得性肺炎186例病原学分析

目的 研究社区获得性肺炎(CAP)的病原体分布,同时观察CURB-65评分与住院时间长短的关系.方法 应用ELISA法对所有入选的CAP患者进行肺炎支原体和肺炎衣原体IgM抗体检测,同时对部分患者行痰液、血液或胸水培养,并依据CURB-65评分对低危组和中危组的住院时间进行比较.结果 186例CAP患者中共有70例(37.6%)检测到病原体.35例(18.8%)痰培养阳性,胸水培养阳性1例(0.5%),血培养均阴性.39例(21.0%)检测到非典型病原体,其中肺炎支原体22例(11.8%)、肺炎衣原体18例(9.7%).混合感染率为14.3%.按CURB-65评分系统,低危组和中危组的平均住院时间无统计学差异.结论 CAP中病原体的检出率不高,非典型病原体占重要地位,混合感染不容忽视,低危组存在住院时间过长的倾向.     

Comparison of hospitalization rates in patients with community-acquired pneumonia treated with telithromycin for 5 or 7 days or clarithromycin for 10 days

SUMMARY

Aims: To compare the impact on hospitalization rates and the clinical efficacy of oral telithromycin and clarithromycin treatment in patients with community-acquired pneumonia (CAP).

Methods: A total of 581 patients with CAP were enrolled in this randomized, double-blind, parallel-group, multinational study, of whom 575 were evaluated for healthcare resource utilization from a payer perspective (intent to treat [ITT] population). Patients received telithromycin 800?mg once daily for 5 (n?=?193) or 7 (n?=?195) days, or clarithromycin 500?mg once daily for 10days (n?=?187). The primary efficacy endpoint was clinical outcome at test of cure (Days 17–24) in the per-protocol population. Frequency of CAP-related hospitalizations, physician visits/tests/procedures, and additional respiratory tract infection-related antibacterial use were compared by treatment group (ITT) up to late post-therapy (Days 31-36). Study investigators blinded to treatment assessed whether hospital admissions were CAP-related or not. CAP-related

hospitalization costs (US$) for telithromycin and clarithromycin were compared.

Results: Clinical cure rates were similar in patients who received clarithromycin for 10days and telithromycin for 5 or 7 days: 91.8% (134/146), 89.3% (142/159), and 88.8% (143/161), respectively, and both 5- and 7-day telithromycin were statistically equivalent to clarithromycin (difference: ?2.5 and ?3.0%, respectively; 95% CI: ?9.7, 4.7 and ?10.2, 4.3, respectively). There were 7 CAP-related hospital admissions among clarithromycin patients vs 3 (p?=?0.283) and 1 (p?=?0.021) admissions among 5- and 7-day telithromycin patients, respectively. The number of hospital days/100 patients was 40.1 for clarithromycin vs 17.1 and 7.2 for 5- and 7-day telithromycin, respectively. Projected hospitalization costs/100 patients were $86205 for clarithromycin vs $37930 (difference: ?26446; 95% CI: ?66654; 13762) and $16 091 (difference: ?37847; 95% CI: ?77953; 2259) for 5- and 7-day telithromycin, respectively.

Conclusions: Data from this study demonstrate that telithromycin 800?mg once daily for 5 or 7 days is an effective treatment for CAP, and that telithromycin treatment of CAP may be associated with fewer hospital days and potentially lower hospitalization costs than clarithromycin treatment.     

头孢地尼颗粒治疗儿童社区获得性细菌性肺炎临床观察

目的：通过观察头孢地尼颗粒剂治疗轻、中度儿童社区获得性细菌性肺炎,评价头孢地尼的疗效和安全性。方法：74例社区获得性肺炎患儿随机分为两组,治疗组34例口服头孢地尼颗粒每次5mg／kg,3次／d,连续5～7d;对照组40例予阿莫西林／克拉维酸30mg／kg静脉滴注,2次／d。连续应用5～7d。结果：治疗组总有效率为85．3％,对照组总有效率80．0％,两组总有效率比较差异无统计学意义（χ^2=0．36,P〉0．05）。结论：头孢地尼颗粒是治疗社区获得性细菌性肺炎安全、有效的药物。     

2型糖尿病合并社区获得性肺炎102例临床分析

目的通过对住院2型糖尿病合并社区获得性肺炎（community—acquired pneumonia,CAP）患者的观察,探讨其临床特点、危险因素和治疗策略。方法对102例2型糖尿病合并社区获得性肺炎患者和116例单纯社区获得性肺炎患者的一般指标进行对比分析,并取痰进行细菌性培养。结果2型糖尿病合并社区获得性肺炎患者组血糖、白细胞计数、C反应蛋白、血沉、降钙素原均明显高于单纯社区获得性肺炎组。肺部感染致病菌主要以口杆菌多见。结论2型糖尿病患者血糖控制不佳易并发肺部感染,在选择抗生素时,首选有效敏感的抗生素是治疗的关键。并改善营养状况,加强患者宣教。     

Substance abuse treatment for mothers: treatment outcomes and the impact of length of stay

This article examines the treatment outcomes of 305 women enrolled in a comprehensive, residential substance abuse treatment program for pregnant and parenting women and their children. The women were assessed at intake and three times in the year after discharge. Analyses focused on change in client functioning over time, and investigating the impact of length of stay in treatment on client outcomes. Comparisons of clients' functioning before and after treatment suggest significant improvements in a number of domains, including substance use, employment, legal involvement, mental health, parenting attitudes, and risky behaviors. For most outcome domains, results suggest that longer treatment stays are associated with more positive outcomes.     

莫西沙星治疗老年患者社区获得性肺炎的疗效

目的观察莫西沙星治疗老年患者社区获得性肺炎（CAP）的疗效及安全性。方法选择本院老年患者80例,随机分成莫西沙星组（实验组）40例和头孢曲松联合左氧氟沙星组（对照组）40例。结果实验组总有效率95%、对照组总有效率77.5%,两组比较有统计学差异（P〈0.05）。实验组的不良反应发生率7.5%,对照组的不良反应发生率10.0%,两组比较差异无统计学意义（P〉0.05）。结论莫西沙星治疗老年CAP安全、有效。     

厄他培南治疗老年社区获得性肺炎的临床疗效和安全性

目的评价厄他培南治疗老年社区获得性肺炎的疗效和安全性。方法 100例老年(≥65岁)社区获得性肺炎患者随机分为2组,每组50例。实验组给予注射用厄他培南1.0 g,1次/d,对照组给予莫西沙星注射液400 mg,1次/d,两组疗程均为7～14 d。观察治疗前后两组的临床疗效。结果实验组治疗有效率为92%,细菌清除率为88.9%;对照组治疗有效率为76%,细菌清除率为69.8%;两组间比较差异有统计学意义(P<0.05)。结论厄他培南治疗老年社区获得性肺炎临床疗效良好,不良反应较少,安全性高。     

左氧氟沙星在重症社区获得性肺炎患者中的药物动力学研究

目的:比较左氧氟沙星治疗重症肺炎的不同用药方案的药物动力学差异,为临床合理用药提供依据.方法:24例成人重症社区获得性肺炎且正在接受机械通气的患者分为两组(n=12),分别每日1次或2次静脉滴注左氧氟沙星500 mg,同时每日滴注1次拉维酸1 g,连续静脉滴注10 d,经过2d的治疗达到稳定状态后利用高效液相色谱法测定血浆和上皮细胞衬液中左氧氟沙星的浓度,并比较两组间药动学参数.结果:每日滴注1次的患者,左氧氟沙星的血浆值浓度和上皮细胞衬液浓度分别为(12.6±2.3) mg/L和(11.9±2.7) mg/L,每日滴注2次的患者分别为(19.7±1.8) mg/L和(17.8±1.7) mg/L,这表明左氧氟沙星在肺组织的穿透率都大于100％.每日滴注1次和2次的患者全身暴露浓度(AUC24h)分别为(151.2±12.8) mg· h· L-1和(208.6±15.1) mg· h· L-1,均高于常见重症肺炎致病菌的最小抑菌浓度(MIC).每日滴注1次组的治疗成功率为83％(10/12),每日滴注2次组为92％(11/12),无统计学差异(P＞0.05).结论:对因重症社区获得性肺炎接受机械通气的危重患者,每日静脉滴注500mg左氧氟沙星1次或2次均能达到最小的抑菌浓度.     

Clinical management of community-acquired pneumonia in young children

Introduction: Community-acquired pneumonia (CAP) is the leading cause of mortality among children under 5 years worldwide. However, the choices of chemical therapy for the empirical treatment of CAP are frequently debated.

Areas covered: The authors provide an update on the chemical management recommendations for childhood CAP. The authors have performed a MEDLINE literature search, using the keywords ‘guidelines,’ ‘community-acquired pneumonia,’ AND ‘children.’ Articles published in English, providing consensual recommendations on management of children >2 months and <5 years with CAP but without HIV infection, were included. Furthermore, the authors discuss the latest evidence guiding the rational use of antibiotics in young children with CAP.

Expert opinion: For the chemical management of CAP, the first-line antibiotic options are amoxicillin (50 mg/kg/day, every 12 h) among ambulatory patients and aqueous penicillin G (200,000 IU/kg/day, every 6 h) or ampicillin (200 mg/kg/day, every 6 h) for hospitalized children. Ceftriaxone can be considered in the treatment of very severe cases. Oxacillin or macrolide may be added in specific situations, if Staphylococcus aureus or atypical bacteria, respectively, are potential etiological agents, although not deemed common. Penicillins remain the first-line choice of antibiotic for the treatment of CAP in young children.     

莫西沙星治疗国内社区获得性肺炎的Meta分析

目的利用Meta分析方法对莫西沙星治疗国内社区获得性肺炎(CAP)的临床试验进行分析,评价其治疗效果。方法检索2002-2010年在国内生物医学期刊发表的有关莫西沙星治疗社区获得性肺炎的临床研究文献,采用Review Manager 4.2软件对符合条件的文献进行荟萃分析。结果共有19个临床试验纳入本次研究,同质性检验χ2=0.30,P>0.05,故采用固定效应模型进行分析。与对照组比较,莫西沙星治疗社区获得性肺炎总有效率更高,比值比为1.94,95%可信区间为1.32～2.84(P<0.05)。结论临床可选用莫西沙星治疗社区获得性肺炎。     

Evidence for moxifloxacin in community-acquired pneumonia: the impact of pharmaco-economic considerations on guidelines

Abstract

Objective:

In an era of limited resources, policy makers and health care payers are concerned about the costs of treatment in addition to its effectiveness. However, guidelines do not tend to consider the cost-effectiveness of treatment options. This paper aims to conduct an international literature review with a view to assessing the impact of pharmaco-economic considerations of CAP treatment with moxifloxacin on recent guidelines.     

排痰方法指导对毛细支气管炎患儿住院时间的影响

目的 观察排痰方法对毛细支气管炎患儿住院时间的影响.方法 将毛细支气管炎患儿128例随机分为对照组与观察组各64例,观察组行常规护理并对家属进行具体排痰方法教育,对照组仅予一般护理教育.比较2组患儿心率、呼吸次数、血氧饱和度、体温、痰液培养结果及住院时间.结果 观察组患儿平均心率、呼吸次数改善状况明显优于对照组;观察组住院时间少于对照组;观察组痰培养结果优于对照组,2组比较差异均有统计学意义（P＜0.05）.结论 排痰方法指导对可有效改善毛细支气管炎患儿症状,减少其住院天数.     

老年社区获得性肺炎细胞免疫与体液免疫状态的临床研究

目的探讨老年社区获得性肺炎（CAP）患者细胞免疫和体液免疫的功能状态。方法老年CAP和老年健康对照组各30例,均于清晨空腹抽取肘静脉血5ml,分别检测CD4＋、CD8＋T细胞亚群、免疫球蛋白IgG、IgA、IgM和补体C3、C4水平。结果老年CAP患者CD4＋、CD8＋T细胞水平和CD4＋/CD8＋比值与老年健康对照组差异无统计学意义（P〉0.05）;IgG水平低于老年健康对照组,差异有统计学意义（P〈0.05）;IgA、IgM、C3和C4水平与老年健康对照组差异无统计学意义（P〉0.05）。结论老年CAP患者存在以IgG水平降低为主的体液免疫功能紊乱。     

血清C反应蛋白变化在社区获得性肺炎病情评估中的价值

目的探讨血清C反应蛋白(CRP)水平的变化在社区获得性肺炎(CAP)病情及预后评估中的价值。方法收集CAP患者356例,初诊时和治疗后第4天检测血清CRP水平,观察符合重症肺炎病例数和随访30 d病死率。采用多元回归分析的方法评估预测价值。结果纳入研究范围的356例患者中,符合重症肺炎34例,30 d病死率是7.0%。较低水平的CRP对30 d病死率显示较高的阴性预测值,CRP<100 mg/L是减少重症肺炎(OR 0.22)(P<0.01)和30 d病死率(OR 0.17)(P<0.05)风险的独立危险因素。263例患者第4天重复测量了血清CRP水平。第4天的CRP水平下降少于50%或升高增加重症肺炎(OR 4.9)(P<0.01)和30 d病死率(OR 20.6)(P<0.01)风险。结论 CRP是评估CAP严重程度的独立预测因素。CRP<100 mg/L提示重症肺炎风险和30 d病死率降低。第4天CRP水平下降不足50%或上升提示重症肺炎风险和30 d病死率增加。