Abstract
Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China. Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients’ baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0. Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p < 0.001). Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.
Highlights
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 report, (Global Strategy for the Diagnosis, Management, 2020) chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease, characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities that are usually caused by significant exposure to noxious particles or gases and influenced by host factors, including abnormal lung development
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are characterized by episodes of worsening of symptoms, resulting in substantial morbidity and mortality. (Wedzicha and Seemungal, 2007) Per the GOLD 2021 report, AECOPD can be classified as mild, moderate, and severe, based on the severity of the disease. (Global, 2020) Patients with mild AECOPD should only be treated with short-acting bronchodilators (SABDs), those with moderate AECOPD are treated with SABDs plus antibiotics and/or oral corticosteroids, while those with severe AECOPD require hospitalization or visits to the emergency room
Our results demonstrate that 86.2% of included AECOPD patients received antibiotic treatment during admission
Summary
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 report, (Global Strategy for the Diagnosis, Management, 2020) chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease, characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities that are usually caused by significant exposure to noxious particles or gases and influenced by host factors, including abnormal lung development. (NICE guideline [NG114], 2020) the GOLD 2021 report indicates that antibiotics are among the three most commonly used classes of medications for treating COPD exacerbations; antibiotics should be administered to AECOPD patients with clinical signs of bacterial infection, for a recommended duration of 5-7°days. The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China
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