KOAH Akut Alevlenmelerinde CRP Rehberliğinde Antibiyoterapi

Amaç: KOAH alevlenmelerinde antibiyotik kullanımı tartışmalıdır. Antibiyotik endikasyonunu belirlemede en sık kullanılan Antonisen kriterleri, antibiyotik tedavisinden fayda görecek hastaları belirlemede yeterince duyarlı değildir. KOAH alevlenmeleri için CRP eşliğinde antibiyotik reçete edilmesinin, zarar kanıtı olmaksızın daha düşük bir oranda antibiyotik kullanımı ile sonuçlandığı bildirilmiştir. Bu çalışma, KOAH alevlenmesinde CRP rehberliğinde antibiyoterapi ile standart yaklaşımı karşılaştırmak amacıyla yapılmıştır.Gereç ve Yöntemler: Akdeniz Üniversitesi Göğüs Hastalıkları polikliniğine KOAH alevlenme nedeniyle başvuran 40 yaş üstü hastalar, kontrol Antonisene göre ve CRP grubu CRP’e göre olarak randomize edildiler. Kontrol grubuna Antonisen kriterlerine göre, CRP grubuna CRP düzeyi >1 mg/dl ise antibiyotik verildi. Hastalar 2. haftada ve 3. ayda, tekrar alevlenme, hastane başvurusu, hastane/YBÜ yatışı açısından değerlendirildi.Bulgular: Çalışma grubundaki hastaların yaş ortalaması 59,5±9,5, kontrol grubundakilerin 60,2±12,5 idi. Gruplar, cinsiyet, sigara kullanım özellikleri, semptomlar, komorbiditeler bakımından da benzerdi. Ortalama antibiyotik kullanım süresi kontrol grubunda 3,83±3,41 gün, CRP grubunda 3,52±3,13 gün idi. Gruplar arasında antibiyotik kullanımı p=0,34 . ve 2. haftada ve 3. ayda tekrar alevlenme, alevlenme nedenli hastane başvurusu, hastane/YBÜ yatışı açısından fark saptanmadı.Sonuç: KOAH alevlenmesinde CRP rehberliğiyle antibiyotik kullanımı azalmadı. CRP rehberliğinde antibiyotik tedavisinin sonuçları standart yaklaşımdan daha kötü değildi. CRP’nin farklı değerlerinin standart yaklaşımdan daha iyi olup olmadığını değerlendirmek için daha geniş hasta sayıları ile yapılacak, randomize, kontrollü yeni çalışmalara gereksinim vardır

Anahtar Kelimeler:

KOAH, CRP, Antibiyotik

CRP-Guided Antibiotherapy in COPD Exacerbation

Objective: Antibiotic use in COPD exacerbations is controversial. The Antonisen criteria, used frequently to determine the antibiotic indication, is not sensitive enough to identify who will benefit from antibiotics. It has been reported that CRP guidance for COPD exacerbations results in decreased antibiotic use without any harm. This study was conducted to compare CRP-guided antibiotherapy and the standard approach.Material and Methods: Patients, over 40 years of age, presenting to the Akdeniz University Chest Diseases outpatient clinic for COPD exacerbation, were randomized as control Antonisen-guided and CRP CRP-guided groups. Antibiotics were given according to the Antonisen criteria in the control group and if CRP was >1 mg/dl in the CRP group. The patients were re-evaluated at 2 weeks and 3 months in terms of re-exacerbation, re-admission and hospitalization/ICU stay due to exacerbation.Results: The mean age was 59.5±9.5 in the study group and 60.2±12.5 in the control group. The groups were similar in terms of gender, smoking characteristics, symptoms, and comorbidities. The mean antibiotic duration was 3.83±3.41 days in the control group and 3.52±3.13 days in the CRP group. There was no difference between the groups in terms of antibiotic usage p=0.34 and reexacerbation, re-admission to the hospital, re-hospitalization and hospitalization/ICU stay at the 2nd week and 3rd month.Conclusion: Antibiotic use was not decreased with CRP guidance. The results of CRP-guided antibiotic therapy, were not worse than the standard approach. To evaluate whether using different values of CRP could be better than the standard approach, new randomized and controlled studies with larger patient populations are required

Keywords:

COPD, CRP, Antibiotic,

PDF

___

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD science committee report 2019.
Afessa B, Morales IJ, Scanlon PD, Peters SG. Prognostic factors, clinical course, and hospital outcome of patients with chronic obstructive pulmonary disease admitted to an intensive care unit for acute respiratory failure. Crit Care Med 2002; 30:1610-5.
Sapey E, Stockley RA. COPD exacerbations 2: Aetiology. Thorax 2006; 61:250-8.
Vestbo J. Clinical assessment, staging, and epidemiology of chronic obstructive pulmonary disease exacerbations. Proc Am Thorac Soc 2006; 3:252-6.
Anthonisen NR, Manfreda J, Warren CP. Antibiotic therapy in exacerbations of chronic obstructive pulmo- nary disease. Ann Intern Med 1987; 106:196-204.
Hurst JR, Donaldson GC, Perera WR, Wilkinson TMA. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary diseas. Am J Respir Crit Care Med 2006; 174(8):867-74.
Weis N, Almdal T. C-reactive protein: Can it be used as a marker of infection in patient with exacerbation of chro- nic obstructive pulmonary disease? Eur J Int Med 2006; 17(2):88-91.
Celli BR, Mac Nee W, ATS/ERS Task Force. Stan- dards for the diagnosis and care of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23:932-46.
Tonkin-Crine SK, Tan PS, vanHecke O, Wang K, Roberts NW, McCullough A, Hansen MP, Butler CC, Del Mar CB. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: An overview of systematic revi- ews. Cochrane Database Syst Rev 2017; 9(9):CD012252.
Melbye H. Community pneumonia: Morehelp is needed to diagnose and assess severity. Br J Gen Pract 2002; 52: 886-8.
Johannes MAD, Marianne S, Dominic S, Knol DL, Lutter R, Jansen HM, Boersma WG. Procalcitonin vs C-Reactive protein as predictive markers of response to antibiotic therapy in acute exacerbations of COPD. Chest 2010; 138(5):1108-15.
Dev D, Wallace E, Sankaran R. Value of C-reactive protein measurements in exacerbations of chronic obstruc- tive pulmonary disease. Respir Med 1998; 92(4):664-7.
Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas- Jones E, Wootton M, Hood K, Phillips R, Melbye H, Llor C, Cals JWL, Naik G, Kirby N, Gal M, Riga E, Francis NA. C-Reactive protein testing to guide antibiotic presc- ribing for COPD exacerbations. N Engl J Med 2019; 381(2):111-20.