Mihaela S Stefan1, Michael B Rothberg2, Meng-Shiou Shieh3, Penelope S Pekow4, Peter K Lindenauer5. 1. Division of General Medicine, Baystate Medical Center, Springfield; Department of Medicine, and Center for Quality of Care Research, Baystate Medical Center, Springfield; Department of Medicine, Tufts University School of Medicine, Boston; Program in Clinical and Translational Research, Sackler School of Graduate Biomedical Sciences, Tufts University, Boston. Electronic address: mihaela.stefan@bhs.org. 2. Division of General Medicine, Baystate Medical Center, Springfield; Department of Medicine, and Center for Quality of Care Research, Baystate Medical Center, Springfield; Department of Medicine, Tufts University School of Medicine, Boston; Sackler School of Graduate Biomedical Sciences, Tufts University, Boston. 3. Department of Medicine, and Center for Quality of Care Research, Baystate Medical Center, Springfield. 4. Department of Medicine, and Center for Quality of Care Research, Baystate Medical Center, Springfield; School of Public Health and Health Sciences, University of Massachusetts-Amherst, MA. 5. Division of General Medicine, Baystate Medical Center, Springfield; Department of Medicine, and Center for Quality of Care Research, Baystate Medical Center, Springfield; Department of Medicine, Tufts University School of Medicine, Boston; Sackler School of Graduate Biomedical Sciences, Tufts University, Boston; Tufts Clinical and Translational Science Institute, Boston.
Abstract
BACKGROUND: Antibiotics are widely used in acute exacerbations of COPD (AE-COPD), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of patients treated with steroids who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens. METHODS: We conducted a retrospective cohort study of patients aged 40 years hospitalized for AE-COPD from January 1, 2006, through December 1, 2007, at 410 acute care hospitals throughout the United States. RESULTS: Of the 53,900 patients who met the inclusion criteria, 85% were treated with antibiotics in the first 2 hospital days; 50% were treated with a quinolone, 22% with macrolides plus cephalosporin, and 9% with macrolide monotherapy. Compared with patients not treated with antibiotics, those who received antibiotics had lower mortality (1% vs 1.8%, P < .0001). In multivariable analysis, receipt of antibiotics was associated with a 40% reduction in the risk of in-hospital mortality (RR, 0.60; 95% CI, 0.50-0.73) and a 13% reduction in the risk of 30-day readmission for COPD (RR, 0.87; 95% CI, 0.79-0.96). The risk of late ventilation and readmission for Clostridium difficile colitis was not significantly different between the two groups. We found little difference in the outcomes associated with three common antibiotic treatment choices. CONCLUSIONS: Our results suggest that the addition of antibiotics to a regimen that includes steroids may have a beneficial effect on short-term outcomes for patients hospitalized with AE-COPD.
BACKGROUND: Antibiotics are widely used in acute exacerbations of COPD (AE-COPD), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of patients treated with steroids who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens. METHODS: We conducted a retrospective cohort study of patients aged 40 years hospitalized for AE-COPD from January 1, 2006, through December 1, 2007, at 410 acute care hospitals throughout the United States. RESULTS: Of the 53,900 patients who met the inclusion criteria, 85% were treated with antibiotics in the first 2 hospital days; 50% were treated with a quinolone, 22% with macrolides plus cephalosporin, and 9% with macrolide monotherapy. Compared with patients not treated with antibiotics, those who received antibiotics had lower mortality (1% vs 1.8%, P < .0001). In multivariable analysis, receipt of antibiotics was associated with a 40% reduction in the risk of in-hospital mortality (RR, 0.60; 95% CI, 0.50-0.73) and a 13% reduction in the risk of 30-day readmission for COPD (RR, 0.87; 95% CI, 0.79-0.96). The risk of late ventilation and readmission for Clostridium difficilecolitis was not significantly different between the two groups. We found little difference in the outcomes associated with three common antibiotic treatment choices. CONCLUSIONS: Our results suggest that the addition of antibiotics to a regimen that includes steroids may have a beneficial effect on short-term outcomes for patients hospitalized with AE-COPD.
Authors: Meyer S Balter; Jacques La Forge; Donald E Low; Lionel Mandell; Ronald F Grossman Journal: Can Respir J Date: 2003 Jul-Aug Impact factor: 2.409
Authors: T A Seemungal; G C Donaldson; E A Paul; J C Bestall; D J Jeffries; J A Wedzicha Journal: Am J Respir Crit Care Med Date: 1998-05 Impact factor: 21.405
Authors: David W Brown; Janet B Croft; Anna P Schenck; Ann Marie Malarcher; Wayne H Giles; Ross J Simpson Journal: Am J Prev Med Date: 2004-02 Impact factor: 5.043
Authors: Laura J Spece; Lucas M Donovan; Matthew F Griffith; Margaret P Collins; Laura C Feemster; David H Au Journal: COPD Date: 2018-10 Impact factor: 2.409
Authors: Yuanyuan Wang; Victor Pera; H Marike Boezen; Jan-Willem C Alffenaar; Bob Wilffert; Rolf H H Groenwold; Eelko Hak Journal: Respiration Date: 2022-01-03 Impact factor: 3.966
Authors: Mihaela S Stefan; Meng-Shiou Shieh; Kerry A Spitzer; Penelope S Pekow; Jerry A Krishnan; David H Au; Peter K Lindenauer Journal: JAMA Intern Med Date: 2019-03-01 Impact factor: 21.873