In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study
Abstract Background The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Aim To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-023-02426-3 |
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| author | Anna Vanoverschelde Chloë Van Hoey Franky Buyle Nadia Den Blauwen Pieter Depuydt Eva Van Braeckel Lies Lahousse |
| author_facet | Anna Vanoverschelde Chloë Van Hoey Franky Buyle Nadia Den Blauwen Pieter Depuydt Eva Van Braeckel Lies Lahousse |
| author_sort | Anna Vanoverschelde |
| collection | DOAJ |
| description | Abstract Background The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Aim To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and to investigate its association with hospital length of stay (LOS) and in-hospital mortality. Methods A retrospective, observational study was conducted in Ghent University Hospital. Severe AECOPD were defined as hospitalizations for AECOPD (ICD-10 J44.0 and J44.1) discharged between 2016 and 2021. Patients with a concomitant diagnosis of pneumonia or ‘pure’ asthma were excluded. An alluvial plot was used to describe antibiotic treatment patterns. Logistic regression analyses identified determinants of in-hospital antibiotic use. Cox proportional hazards regression analyses were used to compare time to discharge alive and time to in-hospital death between antibiotic-treated and non-antibiotic-treated AECOPD patients. Results In total, 431 AECOPD patients (mean age 70 years, 63% males) were included. More than two-thirds (68%) of patients were treated with antibiotics, mainly amoxicillin-clavulanic acid. In multivariable analysis, several patient-related variables (age, body mass index (BMI), cancer), treatment-related variables (maintenance azithromycin, theophylline), clinical variables (sputum volume and body temperature) and laboratory results (C-reactive protein (CRP) levels) were associated with in-hospital antibiotic use independent of sputum purulence, neutrophil counts, inhaled corticosteroids and intensive care unit of which CRP level was the strongest determinant. The median hospital LOS was significantly longer in antibiotic-treated patients (6 days [4–10]) compared to non-antibiotic-treated patients (4 days [2–7]) (p < 0.001, Log rank test). This was indicated by a reduced probability of hospital discharge even after adjustment for age, sputum purulence, BMI, in-hospital systemic corticosteroid use and forced expiratory volume in one second (FEV1) (adjusted hazard ratio 0.60; 95% CI 0.43; 0.84). In-hospital antibiotic use was not significantly associated with in-hospital mortality. Conclusions In this observational study in a Belgian tertiary hospital, in-hospital antibiotic use among patients with severe AECOPD was determined by the symptom severity of the exacerbation and the underlying COPD severity as recommended by the guidelines, but also by patient-related variables. Moreover, in-hospital antibiotic use was associated with a longer hospital stay, which may be linked to their disease severity, slower response to treatment or 'harm' due to antibiotics. Trial registration Number: B670201939030; date of registration: March 5, 2019. |
| first_indexed | 2024-04-09T15:12:41Z |
| format | Article |
| id | doaj.art-45c54d99cea24e28a744303e655a8acc |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-09T15:12:41Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-45c54d99cea24e28a744303e655a8acc2023-04-30T11:06:11ZengBMCBMC Pulmonary Medicine1471-24662023-04-0123111410.1186/s12890-023-02426-3In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational studyAnna Vanoverschelde0Chloë Van Hoey1Franky Buyle2Nadia Den Blauwen3Pieter Depuydt4Eva Van Braeckel5Lies Lahousse6Department of Bioanalysis, Pharmaceutical Care Unit, Ghent UniversityDepartment of Bioanalysis, Pharmaceutical Care Unit, Ghent UniversityDepartment of Pharmacy, Ghent University HospitalMedical Coding Department, Ghent University HospitalDepartment of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent UniversityDepartment of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent UniversityDepartment of Bioanalysis, Pharmaceutical Care Unit, Ghent UniversityAbstract Background The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Aim To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and to investigate its association with hospital length of stay (LOS) and in-hospital mortality. Methods A retrospective, observational study was conducted in Ghent University Hospital. Severe AECOPD were defined as hospitalizations for AECOPD (ICD-10 J44.0 and J44.1) discharged between 2016 and 2021. Patients with a concomitant diagnosis of pneumonia or ‘pure’ asthma were excluded. An alluvial plot was used to describe antibiotic treatment patterns. Logistic regression analyses identified determinants of in-hospital antibiotic use. Cox proportional hazards regression analyses were used to compare time to discharge alive and time to in-hospital death between antibiotic-treated and non-antibiotic-treated AECOPD patients. Results In total, 431 AECOPD patients (mean age 70 years, 63% males) were included. More than two-thirds (68%) of patients were treated with antibiotics, mainly amoxicillin-clavulanic acid. In multivariable analysis, several patient-related variables (age, body mass index (BMI), cancer), treatment-related variables (maintenance azithromycin, theophylline), clinical variables (sputum volume and body temperature) and laboratory results (C-reactive protein (CRP) levels) were associated with in-hospital antibiotic use independent of sputum purulence, neutrophil counts, inhaled corticosteroids and intensive care unit of which CRP level was the strongest determinant. The median hospital LOS was significantly longer in antibiotic-treated patients (6 days [4–10]) compared to non-antibiotic-treated patients (4 days [2–7]) (p < 0.001, Log rank test). This was indicated by a reduced probability of hospital discharge even after adjustment for age, sputum purulence, BMI, in-hospital systemic corticosteroid use and forced expiratory volume in one second (FEV1) (adjusted hazard ratio 0.60; 95% CI 0.43; 0.84). In-hospital antibiotic use was not significantly associated with in-hospital mortality. Conclusions In this observational study in a Belgian tertiary hospital, in-hospital antibiotic use among patients with severe AECOPD was determined by the symptom severity of the exacerbation and the underlying COPD severity as recommended by the guidelines, but also by patient-related variables. Moreover, in-hospital antibiotic use was associated with a longer hospital stay, which may be linked to their disease severity, slower response to treatment or 'harm' due to antibiotics. Trial registration Number: B670201939030; date of registration: March 5, 2019.https://doi.org/10.1186/s12890-023-02426-3Chronic obstructive pulmonary diseaseSevere exacerbationsAntibiotics |
| spellingShingle | Anna Vanoverschelde Chloë Van Hoey Franky Buyle Nadia Den Blauwen Pieter Depuydt Eva Van Braeckel Lies Lahousse In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study BMC Pulmonary Medicine Chronic obstructive pulmonary disease Severe exacerbations Antibiotics |
| title | In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study |
| title_full | In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study |
| title_fullStr | In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study |
| title_full_unstemmed | In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study |
| title_short | In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study |
| title_sort | in hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations a retrospective observational study |
| topic | Chronic obstructive pulmonary disease Severe exacerbations Antibiotics |
| url | https://doi.org/10.1186/s12890-023-02426-3 |
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