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Original Research: COPD |

Association Between Antibiotic Treatment and Outcomes in Patients Hospitalized With Acute Exacerbation of COPD Treated With Systemic SteroidsAntibiotics and Steroids in Exacerbation of COPD

Mihaela S. Stefan, MD; Michael B. Rothberg, MD, MPH; Meng-Shiou Shieh, PhD; Penelope S. Pekow, PhD;; Peter K. Lindenauer, MD
Author and Funding Information

From the Division of General Medicine (Drs Stefan, Rothberg, and Lindenauer), Department of Medicine, and Center for Quality of Care Research (Drs Stefan, Rothberg, Shieh, Pekow, and Lindenauer), Baystate Medical Center, Springfield; Department of Medicine (Drs Stefan, Rothberg and Lindenauer), Tufts University School of Medicine, Boston; Program in Clinical and Translational Research, Sackler School of Graduate Biomedical Sciences (Dr Stefan), and Sackler School of Graduate Biomedical Sciences (Drs Rothberg and Lindenauer), Tufts University, Boston; Tufts Clinical and Translational Science Institute (Dr Lindenauer), Boston; and School of Public Health and Health Sciences (Dr Pekow), University of Massachusetts-Amherst, MA.

Correspondence to: Mihaela Stefan, MD, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199; e-mail: mihaela.stefan@bhs.org


Funding/Support: Dr Stefan is supported by the National Cancer Institute [Grant KM1 CA156726] and by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health [Grant UL1 RR025752].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):82-90. doi:10.1378/chest.12-0649
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Background:  Antibiotics are widely used in acute exacerbations 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 patients treated with steroids who were hospitalized with AE-COPD and compared the effectiveness of three commonly used antibiotic regimens.

Methods:  We conducted a 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 with patients not treated with antibiotics, those who received antibiotics had lower mortality (1% vs 1.8%, P < .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 Clostridium difficile colitis was not significantly different between the two groups. We found little difference in the outcomes associated with three 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.

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