TY -的T1 CRP-guided抗生素治疗是一种安全的方式来减少抗生素的使用在严重的急性加重的慢性阻塞性肺病患者住院吗?摩根富林明-欧洲呼吸杂志》乔和J - 10.1183/13993003.01597 -2019欧元六世- 54 - 4 SP - 1901597 AU -普林斯,Henk-Jan AU -范德·沃夫Tjip s . AU - Boersma维姆·g·Y1 - 2019/10/01 UR - //www.qdcxjkg.com/content/54/4/1901597.abstract N2 -我们感谢m . Miravitlles和他的同事们的兴趣我们的工作[1]。他们表达担忧我们的失败率:24%在10天,45%在30天;他们认为31%的患者c反应蛋白(CRP)的全球倡议的组和46%的患者慢性阻塞性肺疾病(黄金)策略组使用抗生素治疗急性慢性阻塞性肺病恶化低住院患者的高危人群。虽然治疗失败是高在我们的研究中,它反映了人口的严重程度。事实上,患者对抗菌素的比例低于门诊研究人口在最近发表的试验从英国[2];然而,我们的慢性阻塞性肺病人口更严重,由住院病人。他们关心的是安全:我们在由扣缴抗菌治疗的患者造成伤害?第一,在我们的研究人群,没有显著差异在失败率天10到30之间的CRP和黄金集团强烈反对他们的观点,抗菌素治疗可能阻止有害事件(表1)。无论是在承认失败,也没有复发明显不同的两个研究部门之间。事实上,复发患者急性加重的慢性阻塞性肺病住院[3]很常见,尤其是在个人在1 s用力呼气量较低,但抗菌治疗不一定防止这种情况,尤其是在那些低炎症标记物。 Slow recovery and early relapse have also been associated with increased inflammation, e.g. reflected by persistently increased CRP, and in patients characterised by chronic bronchitis [4], but whether these individuals might benefit from antimicrobial treatment if their CRP is below a given threshold has not been addressed in clinical studies [5]. An earlier study suggested that patients with CRP >50 mg·L−1 benefit more from antibiotic treatment compared to patients with CRP below this threshold [6]. Second, they argue that perhaps the active study arm treated with co-amoxiclav as the primary antimicrobial agent might have been inadequate. Although antimicrobial susceptibility data have not been listed in our paper, Pseudomonas spp. or other high-risk pathogens were covered if retrieved from sputum, and patients known to have colonisation with high-risk pathogens were provided with tailored antimicrobial regimens.CRP-guided antibiotic treatment reduces antibiotic prescription in acute exacerbation without change in treatment failure http://bit.ly/33IweWG ER -