文章摘要

系统性红斑狼疮患者社区获得性肺炎的抗菌药物疗程及其影响因素

作者: 1赵成刚, 1杨晓秋, 1陶新, 1张超
1 上海市嘉定区南翔医院急诊科,上海 20180
通讯: 张超 Email: zhangchao103202@126.com
DOI: 10.3978/j.issn.2095-6959.2020.09.023

摘要

目的:分析系统性红斑狼疮(systemic lupus erythematosus,SLE)患者社区获得性肺炎的抗菌药物疗程及其影响因素,为临床合理用药提供理论依据。方法:纳入南翔医院及仁济医院2012年1月至2018年12月收治的SLE合并社区获得性肺炎的住院患者。统计此类患者抗菌药物疗程(总体疗程、静脉给药及口服给药疗程),并分析其与肺炎严重程度指数及临床稳态时间的相关性。经多元logistic回归分析,明确导致此类患者抗菌药物疗程>10 d的影响因素。结果:共纳入276名患者,抗菌药物平均疗程为14.6 d,且与肺炎严重程度指数呈正相关(r2=0.24,P<0.0001)。肺炎临床稳态时间与抗菌药物总疗程(r2=0.08,P<0.0001)及静脉抗菌药物疗程(r2=0.69,P<0.0001)呈正相关。CD4/CD8<1 (OR=4.911,95% CI:2.885~8.225)、收治于重症监护病房(OR=3.501,95% CI:1.191~9.283)、抗菌药物二联或三联使用(OR=4.911,95% CI:2.885~8.225)是导致疗程>10 d的独立影响因素(P<0.05)。肺炎严重程度指数对于抗菌药物总疗程>10 d具有预测作用,最佳截断点为139,敏感性为73.33%,特异性为74.07%。结论:SLE患者发生社区获得性肺炎后抗菌药物疗程长,肺炎严重程度指数及宿主自身免疫状态是决定疗程的主要因素。
关键词: 社区获得性肺炎;系统性红斑狼疮;抗菌药物;肺炎严重程度指数;疗程

Duration of antibiotic treatment and its influencing factors in systemic lupus erythematosus patients with community-acquired bacterial pneumonia

Authors: 1ZHAO Chenggang, 1YANG Xiaoqiu, 1TAO Xin, 1ZHANG Chao
1 Department of Emergency, Nanxiang Hospital of Jiading District, Shanghai 201802, China

CorrespondingAuthor: ZHANG Chao Email: zhangchao103202@126.com

Abstract

Objective: To investigate the duration of antibiotic therapy and its influencing factors in treating systemic lupus erythematosus (SLE) patients with community-acquired bacterial pneumonia (CABP). Methods: SLE patients with CABP were enrolled in this retrospective study from January 2012 to December 2018. The duration of antibiotic treatment (total, intravenous and oral) and its correlations with the severity of pneumonia and with the time to clinical stability (TCS) were analysed. A multivariate analysis was performed using a logistic regression model to determine the factors influencing the total antibiotic treatment course >10 d. Results: Two hundred seventy-six patients were finally enrolled in the study, and the mean duration of total antibiotic therapy was 14.6 days. The pneumonia severity index (PSI) was related to the total duration of therapy (r2=0.24, P<0.0001). The TCS was related to the total (r2=0.08, P<0.0001) and intravenous duration of antibiotic therapy (r2=0.69, P<0.0001). The CD4/CD8 ratio <1 (OR=4.911, 95% CI: 2.885–8.225), ICU admission (OR=3.501, 95% CI: 1.191–9.283), and double or triple antibiotic therapy (OR=4.911, 95% CI: 2.885–8.225) were the top three influencing factors (P<0.05, respectively). The optimum cut-off value for the PSI in predicting the total antibiotic therapy course >10 days was 139, yielding a sensitivity and a specificity of 73.33% and 74.07%, respectively. Conclusion: The duration of antibiotic therapy in hospitalised SLE patients with CABP was longer than the course recommended by practice guidelines. The severity of the disease and the host’s immune status might influence the duration of treatment.
Keywords: community-acquired bacterial pneumonia; systemic lupus erythematosus; antibiotics; pneumonia severity index; duration