Off Topic - info - COPD

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Off Topic - info - COPD

Outcomes of Acute COPD Exacerbations May Be Better With Early Antibiotics -

http://www.medscape.com/viewarticle/722400

Outcomes of Acute COPD Exacerbations May Be Better With Early Antibiotics

Laurie Barclay, MD

May 25, 2010 — Outcomes may be better when patients hospitalized for acute

exacerbations of chronic obstructive pulmonary disease (COPD) receive early

antibiotics, according to the results of a retrospective cohort study reported

in the May 26 issue of the Journal of the American Medical Association.

" Acute exacerbations of COPD are responsible for more than 600,000

hospitalizations annually, resulting in direct costs of more than $20 billion, "

write B. Rothberg, MD, MPH, from Baystate Medical Center in Springfield,

Massachusetts, and colleagues. " ...Guidelines recommend antibiotic therapy for

acute exacerbations of COPD, but the evidence is based on small, heterogeneous

trials, few of which include hospitalized patients. "

The goal of the study was to compare the outcomes of patients at least 40 years

old who received antibiotics in the first 2 days of hospitalization for COPD vs

those who received antibiotics later or not at all. The primary study endpoint

was a composite measure of treatment failure, defined as starting mechanical

ventilation after the second hospital day, death during hospitalization, or

readmission for acute exacerbations of COPD within 30 days of discharge. Other

outcomes were length of stay and hospital costs.

At 413 acute care facilities throughout the United States, 84,621 patients were

hospitalized from January 1, 2006, through December 31, 2007, for acute COPD

exacerbations, and 79% of these received at least 2 consecutive days of

antibiotic treatment. Compared with patients who did not receive antibiotics,

those who did were less likely to receive mechanical ventilation after the

second hospital day (1.07%; 95% confidence interval [CI], 1.06% - 1.08% vs

1.80%; 95% CI, 1.78% - 1.82%). In addition, they had lower death rates during

hospitalization (1.04%; 95% CI, 1.03% - 1.05% vs 1.59%; 95% CI, 1.57% - 1.61%)

and lower readmission rates for acute COPD exacerbations (7.91%; 95% CI, 7.89% -

7.94% vs 8.79%; 95% CI, 8.74% - 8.83%).

Rate of readmissions for Clostridium difficile infectionwere higher in patients

who received early antibiotics vs those not treated (0.19%; 95% CI, 0.187% -

0.193% vs 0.09%; 95% CI, 0.086% - 0.094%). Risk for treatment failure was lower

in antibiotic-treated patients (odds ratio, 0.87; 95% CI, 0.82 - 0.92) after

multivariable adjustment that included the propensity for antibiotic treatment.

Findings were similar using a grouped treatment approach and hierarchic modeling

to account for possible confounding of hospital effects. All subgroups defined

by risk for treatment failure had similar degrees of benefit.

" Early antibiotic administration was associated with improved outcomes among

patients hospitalized for acute exacerbations of COPD regardless of the risk of

treatment failure, " the study authors write.

Limitations of this study include observational design; possible selection bias;

possible residual confounding; and use of administrative data, preventing direct

adjustments for physiologic differences between treated and untreated patients.

In addition, there is no validated method to identify patients with acute COPD

exacerbations through administrative data review.

" [W]e found little evidence of harm associated with antibiotic prescribing—we

noted no increase in allergic reactions and only a slight increase in

readmissions with C difficile diarrhea, " the study authors conclude. " Patients

receiving antibiotics may have a slightly longer length of stay or may have

experienced other unmeasured complications. For example, we had no way of

measuring the acquisition of antibiotic-resistant bacteria.... ntil more data

are available, routine use of antibiotics for acute exacerbations of COPD may be

appropriate. "

The study authors have disclosed no relevant financial relationships.

JAMA. 2010;303:2035-2042.

Medscape Medical News © 2010 Medscape, LLC

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