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Antibiotics are widely used in acute exacerbation of COPD (AE-COPD), but their additional benefit to a therapeutic regimen that already includes steroids is uncertain. We evaluated the association between antibiotic therapy and outcomes among a large cohort of steroid treated patients who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens.
METHODS: Retrospective cohort study of patients aged ≥ 40 years hospitalized for AE-COPD from January 1, 2006 through December 1, 2007 at 410 acute care hospitals throughout the United States.
RESULTS: Of the 53,900 patients who met the inclusion criteria 85% were treated with antibiotics in the first 2 hospital days; 50% were treated with a quinolone, 22% with macrolides plus cephalosporin and 9% with macrolide monotherapy. Compared to patients not treated with antibiotics, those who received antibiotics had lower mortality (1% vs. 1.8%, p<0.0001). In multivariable analysis, receipt of antibiotics was associated with a 40% reduction in the risk of in-hospital mortality (RR 0.60, 95% CI, 0.50-0.73) and a 13% reduction in the risk of 30-day readmission for COPD (RR 0.87, 95% CI, 0.79-0.96). The risk of late ventilation and readmission for C difficile colitis was not significantly different between the two groups. We found little difference in the outcomes associated with 3 common antibiotic treatment choices.
CONCLUSIONS: Our results suggest that the addition of antibiotics to a regimen that includes steroids may have a beneficial effect on short-term outcomes for patients hospitalized with AE-COPD.
Authors: Stefan MS, Rothberg MB, Shieh MS, Pekow PS, Lindenauer PK
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