Implication of Clinical Pathway Care for Community-Acquired Pneumonia in a Community Hospital: Early Switch from an Intravenous β-lactam Plus a Macrolide to an Oral Respiratory Fluoroquinolone
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概要
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Objective The effect of clinical pathway (CP) care and early switch from intravenous to oral antibiotics therapy on community-acquired pneumonia (CAP) has been well documented. However, limited studies have evaluated the effects of CP on reducing time taken for attaining clinical stability and duration of antibiotics prescriptions. This study was aimed to investigate the use of a CP and its implication for CAP in a community hospital. Methods We conducted a retrospective cohort study of CAP patients hospitalized between November 2005 and January 2007. The patients were divided into two groups, those for whom CP was adopted and those for whom CP was not adopted on admission. We compared the outcomes of three risk classes assessed using the severity scoring system (A-DROP). CP included switching from an intravenous β-lactam plus a macrolide to an oral respiratory fluoroquinolone, when the patients exhibited risk factors for drug-resistant pneumococci. Results One hundred thirty-five patients were evaluated, and sixty received CP care. Patients in the CP group had a lower A-DROP score. Although clinical cure proportions were similar, the CP group in the mild and moderate classes (A-DROP score, ≤2) required significantly less time to achieve clinical stability and had a reduced duration of total antibiotics prescriptions, length of hospital stay, and hospital charges. These effects were absent in the severe class. Conclusion Implementation of this CP would lead to effective care, may serve to reduce time for attaining clinical stability and reduce the use of unnecessary antibiotics without worsening clinical outcomes in mild and moderate CAP.
著者
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Hasegawa Yoshinori
Department Of Biological Mechanisms And Functions Graduate School Of Bioagricultural Sciences Nagoya
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Sato Shinji
Department Of Accelerator And Medical Physics National Institute Of Radiological Sciences
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Ogawa Masahiro
Department Of Anesthesiology Nihon University School Of Medicine
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Imaizumi Kazuyoshi
Department Of Respiratory Medicine Nagoya University Graduate School Of Medicine
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Maruyama Eiichi
Department of Respiratory Medicine, Handa City Hospital
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Shindo Yuichiro
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine
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Ohashi Takamasa
Department of Respiratory Medicine, Handa City Hospital
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Sato Shinji
Department of Respiratory Medicine, Handa City Hospital
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