合并社区获得性肺炎的心力衰竭患者抗生素使用分析

Analysis of Antibiotic Use in Patients with Community-Acquired Pneumonia and Heart Failure

摘要: 背景：肺炎是诱发急性心力衰竭最常见的诱因之一，临床最常用的β酰胺类与喹诺酮类抗生素对于合并社区获得性肺炎的心力衰竭患者预后尚不清楚。本研究旨在比较两类抗生素对合并社区获得性肺炎的心力衰竭患者预后影响，并分析此类人群再住院相关的预测因子。方法与结果：本研究共纳入548例心力衰竭合并社区获得性肺炎患者。共有429例患者使用抗生素。此类人群最常用的抗生素分别为β内酰胺类(77.2%)、喹诺酮类(44.1%)、大环内酯类(11.7%)。根据单独使用β内酰胺类及喹诺酮类抗生素分组，106例单独使用β酰胺类(62.0%)，65例单独使用喹诺酮类(38.0%)。两组患者基线特征平衡。logistic回归分析表明两种抗生素对合并社区获得性肺炎的心力衰竭患者30天内再入院或院内死亡的复合终点发生风险无差异(21.7% vs 13.8%, P = 0.205)。进一步多因素回归分析发现合并冠心病、肾功能不全、脑梗死的患者发生30天内再入院或院内死亡的风险分别是不合并上述并发症患者的7.48倍(OR: 7.48; 95%CI: 2.03~27.59; P < 0.01)、4.02倍(OR: 4.02; 95%CI: 1.38~11.76; P = 0.01)及4.32倍(OR: 4.32; 95%CI: 1.46~12.77; P < 0.01)。结论：使用β内酰胺类及喹诺酮类抗生素对于合并社区获得性肺炎的心力衰竭患者预后无显著差异。合并冠心病、肾功能不全、脑梗死的患者预后更差，需要及早识别并积极治疗。

Abstract: Background: Pneumonia is one of the most common causes of acute heart failure. The prognosis for patients with heart failure who are also suffering from community-acquired pneumonia and are treated with the commonly used β-lactam and quinolone antibiotics is not well understood. This study aims to compare the impact of these two types of antibiotics on the prognosis of heart failure patients with community-acquired pneumonia and to analyze the predictive factors for readmission in this population. Methods and Results: A total of 548 patients with heart failure and community-acquired pneumonia were included in this study. Of these, 429 patients received antibiotics. The most commonly used antibiotics were β-lactams (77.2%), quinolones (44.1%), and macrolides (11.7%). Based on the use of β-lactams or quinolones alone, 106 patients received β-lactams alone (62.0%), and 65 patients received quinolones alone (38.0%). The baseline characteristics of the two groups were balanced. Logistic regression analysis indicated that there was no difference in the risk of the composite endpoint of readmission within 30 days or in-hospital death between the two types of antibiotics (21.7% vs 13.8%, P = 0.205). Further multivariate regression analysis found that patients with comorbidities such as coronary heart disease, renal insufficiency, and cerebral infarction had a risk of readmission within 30 days or in-hospital death that was 7.48 times (OR: 7.48; 95%CI: 2.03 ~ 27.59; P < 0.01), 4.02 times (OR: 4.02; 95%CI: 1.38~11.76; P = 0.01), and 4.32 times (OR: 4.32; 95%CI: 1.46~12.77; P < 0.01) higher, respectively, than those without these complications. Conclusion: There is no significant difference in the prognosis of heart failure patients with community-acquired pneumonia treated with β-lactam or quinolone antibiotics. Patients with comorbidities such as coronary heart disease, renal insufficiency, and cerebral infarction have a worse prognosis and require early identification and active treatment.