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. 2013 Jan;143(1):82-90.
doi: 10.1378/chest.12-0649.

Association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of COPD treated with systemic steroids

Mihaela S Stefan  1 , Michael B Rothberg  2 , Meng-Shiou Shieh  3 , Penelope S Pekow  4 , Peter K Lindenauer  5
Affiliations

Association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of COPD treated with systemic steroids

Mihaela S Stefan et al. Chest. 2013 Jan.

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.

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Figures

Figure 1.
Figure 1.
Patient selection flow diagram. AE-COPD = acute exacerbation of COPD.
Figure 2.
Figure 2.
Outcomes of early antibiotic treatment vs late or not-treated in patients hospitalized for acute exacerbation of COPD.
Figure 3.
Figure 3.
Sensitivity analysis to estimate the potential impact of unmeasured confounding.
See this image and copyright information in PMC

Comment in

  • Antibiotic use in COPD exacerbations.
    Patel JK. Patel JK. Chest. 2013 Aug;144(2):716. doi: 10.1378/chest.13-0723. Chest. 2013. PMID: 23918130 No abstract available.
  • Response.
    Stefan MS, Lindenauer PK. Stefan MS, et al. Chest. 2013 Aug;144(2):716-717. doi: 10.1378/chest.13-1066. Chest. 2013. PMID: 23918131 No abstract available.

References

    1. Cote CG, Celli BR. Predictors of mortality in chronic obstructive pulmonary disease. Clin Chest Med. 2007;28(3):515-524 - PubMed
    1. Berkius J, Nolin T, Mårdh C, Karlström G, Walther SM; Swedish Intensive Care Registry Characteristics and long-term outcome of acute exacerbations in chronic obstructive pulmonary disease: an analysis of cases in the Swedish Intensive Care Registry during 2002-2006. Acta Anaesthesiol Scand. 2008;52(6):759-765 - PubMed
    1. NHLBI morbidity and mortality chartbook. National Heart, Lung and Blood Institute website. http://www.nhlbi.nih.gov/resources/docs/cht-book.htm. Accessed June 1, 2011.
    1. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(5 pt 1):1418-1422 - PubMed
    1. Snow V, Lascher S, Mottur-Pilson C; Joint Expert Panel on Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2001;134(7):595-599 - PubMed

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