Evaluation der antibiotischen Therapie bei Patienten mit der Diagnose "Ambulant erworbene Pneumonie"
Evaluation of antibiotic therapy in patients diagnosed with "community-acquired pneumonia"
by Irina Pavlova
Date of Examination:2022-03-22
Date of issue:2022-03-15
Advisor:Prof. Dr. Sabine Blaschke-Steinbrecher
Referee:Prof. Dr. Dr. Helmut Eiffert
Referee:Prof. Dr. Ralf Dressel
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EnglishPneumonias are among the most common infectious diseases worldwide and they are associated with high lethality . The demographic development in Germany shows a tendency towards an older society. Increasing life expectancy with consecutive case increase of hospitalized patients with pneumonia has a strong impact on overall health care system. This retrospective, monocentric clinical study was comprised of 226 patients. These patients were presented to our interdisciplinary emergency department at University Medicine Göttingen between March 2016 and July 2017. Inclusion criterion was the diagnosis Community-acquired pneumonia. Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. Exclusion criteria were Age<18, nosocomial pneumonia, acute exacerbated chronic obstructive lung disease and non-CAP. Statistical analysis was focused on two endpoints: Inpatient length of stay and death. The primary aim of this dissertation was to evaluate the quality of the antibiotic therapy administered at the time of diagnosis in the community acquired pneumonia. Results: 92% of the total patients received an antibiotic therapy. The most common initial antibiotics in the Interdisciplinary Emergency Department were Ampicillin/Sulbactam + Clarithromycin, Ampicillin/Sulbactam und Piperacillin/Tazobactam. The preferred antibiotics administration with a frequency of 85% was intravenous administration. The longest antibiotic therapy was administered in the subgroup with CRB-65 Score of 4 (mean duration of 15.7 days). The mean inpatient length of stay of all patients was 12 days. Microbiological diagnostics was performed in 82% of all patients and 116 different pathogens were detected. A potential pneumonia agent was present in 28.5%. In 38% of cases, no change in therapy was necessary, as the results of microbiologically was deemed. In 41% of cases a change of therapy was made in accordance with the antibiogram. Statistical analysis of how the variables age, initial CRB-65-Score and escalation of initial antibiotic therapy influence the endpoint "Inpatient length of stay" showed a significant impact of the variable escalation of antibiotic therapy. When the escalation does not occur, inpatient length of stay decreases by 22.5%. Statistical analysis of how the variables age, initial CRB-65-Score, escalation of initial antibiotic therapy and initial CRP Level influence the endpoint "Death" showed that the probability of death in the subgroup with CRB-65-Score 3 was increased by a factor of 10 and in the subgroup with CRB-65-Score 2 - by a factor of 4. Of a total of 226 patients, 22 died. This represents 9.7%. Considering that 10 patients refused intensive therapy the lethality was still 5.3%. Conclusion: Community-acquired pneumonia is a serious disease in emergency and intensive care. The quality of antibiotic therapy in patients diagnosed with "community-acquired pneumonia " at University Medicine Göttingen met the requirements of the S3-guideline from 2016. However, there is a need to increase the sufficiency of therapy administered to reduce lethality and to improve documentation and collaboration with the microbiology staff.
Keywords: Community-acquired pneumonia; antibiotic therapy; CRB-65-Score
Schlagwörter: Ambulant erworbene Pneumonie; antibiotische Therapie; CRB-65-Score