In a significant investigation into the clinical management of pulmonary ground-glass nodules (GGNs), researchers at West China Hospital of Sichuan University examined the often-prescribed role of antibiotics for patients presenting with these nodules. Their findings suggest that the use of antibiotics may have limited clinical benefits, particularly in patients with suspected infections.
This retrospective study analyzed data from a total of 2,609 participants identified between August 10, 2018, and July 22, 2022, with incidentally detected GGNs. Ultimately, the study focused on 867 patients, comprising 184 who received antibiotic treatment and 683 who did not. The research revealed that 85.2% of these patients were never smokers, while 34.7% presented with respiratory symptoms, raising questions about the appropriateness of antibiotic use in this context.
The decisions to prescribe antibiotics were notably associated with the presence of respiratory symptoms and larger nodule sizes. Among the antibiotic users, the rate of surgical resection was significantly higher at 40.8%, compared to 29.9% among matched controls, with a p-value indicating statistical significance (p = 0.049). However, there was a trend suggesting an increase in lung cancer diagnosis that did not reach statistical significance (32.6% vs. 22.8%, p = 0.054).
Despite these findings, the study reported no significant differences in radiographic responses between the two groups. Even patients suspected of having an infection did not show expected improvements, leading the authors to conclude that, "there are limited beneficial effects of antibiotic use in the management of GGNs, even among patients with suspected infection." This raises concerns over the common practice of prescribing antibiotics empirically for GGNs.
The research provides insight into a growing issue in the medical community regarding antibiotic resistance. With the extensive application of low-dose computed tomography leading to a higher detection rate of GGNs, it is critical to differentiate between benign and malignant nodules correctly. More importantly, the indiscriminate use of antibiotics can exacerbate resistance problems.
The study cohort's demographics reflected a median age of 52, with a notable proportion of females (68.1%) and a substantial number showing respiratory symptoms, specifically cough being the most common (26.9%). Patients who received antibiotics tended to have more prominent nodules at detection and underwent subsequent follow-up CT scans sooner than non-users.
Among the participants diagnosed with lung cancer, an alarming 95.8% had shown no response to antibiotic treatment when reviewed in follow-up scans. This statistic emphasizes the inefficacy of such treatment for this population: "Antibiotic recipients without respiratory symptoms were more likely to undergo subsequent surgical resection," the authors stated, indicating a potential mismanagement of resources.
Throughout the study, a stark contrast was drawn between the outcomes of antibiotic users and non-users. While surgical intervention was more common among those treated with antibiotics, this did not translate to improved radiographic results, suggesting that antibiotic prescriptions might skew clinical decisions rather than provide genuine therapeutic benefits.
The findings from this study underscore the urgent need for antibiotic stewardship programs tailored for patients with GGNs. Given the propensity for overprescribing in many areas, particularly in regions like China where antibiotic consumption remains high, healthcare professionals are encouraged to reconsider the necessity of antibiotic treatments in such cases.
In conclusion, this research highlights the limited clinical benefits of antibiotic use in managing pulmonary ground-glass nodules, a finding that should prompt careful consideration in clinical settings. As healthcare providers grapple with balancing effective treatments against the risks of antibiotic resistance, the study calls for deeper investigations into best practices for treating GGNs, particularly in populations considered at high risk for lung malignancies.
