全球精选文摘 - 口服β-内酰胺类及非β-内酰胺类抗生素治疗非复杂性蜂窝织炎的疗效

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口服β-内酰胺类及非β-内酰胺类抗生素治疗非复杂性蜂窝织炎的疗效

Efficacy of Oral β-Lactam versus Non-β-Lactam Treatment of Uncomplicated Cellulitis

Madaras-Kelly KJ, Remington RE, Oliphant CM 2009/5/27 10:49:53

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Am J Med, 2008,

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Abstract
Background:
Preferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.

Methods:
A multicenter retrospective cohort study of outpatients treated for cellulitis was conducted to compare clinical failure rates of oral β-lactam and non-β-lactam treatments. Exclusion criteria included purulent infection requiring incision and drainage, complicated skin and soft tissue infection, chronic ulceration, and intravenous antibiotics. Failure rates were compared using logistic regression to adjust for both covariates associated with failure and a propensity score for β-lactam treatment.

Results:
Of 2977 patients, 861 met inclusion criteria and were classified by treatment: β-lactam (n=631) or non-β-lactam therapy (n=230). Failure rates were 14.7% versus 17.0% (odds ratio [OR] 0.85, 95% confidence interval [CI], 0.56-1.31) for β-lactam and non-β-lactam therapy, respectively. Failure was associated with: age (P=.02), acute symptom severity (P=.03), animal bites (P=.03), Charlson score >3 (P=.02), and histamine-2 receptor antagonist use (P=.09). Relative efficacy of β-lactam therapy was greater after adjustment for factors associated with failure but remained statistically insignificant (adjusted OR 0.81, 95% CI, 0.53-1.24); adjusted including propensity score covariate (OR 0.71, 95% CI, 0.45-1.13). Discontinuation due to adverse effects differed between β-lactam (0.5%) and non-β-lactam (2.2%) therapies (P=.04).

Conclusion:
There was no significant difference in clinical failure between β-lactam and non-β-lactam antibiotics for the treatment of uncomplicated cellulitis. Increased discontinuation, due to adverse events with non-β-lactam therapy, was observed.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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