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Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.
Arch Intern Med. 2004 Mar 22; 164(6):637-44.AI

Abstract

BACKGROUND

Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital.

METHODS

We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS).

RESULTS

Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics.

CONCLUSIONS

Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.

Authors+Show Affiliations

Centers for Medicare & Medicaid Services, Seattle, WA 98121, USA. phouck@cms.hhs.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15037492

Citation

Houck, Peter M., et al. "Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-acquired Pneumonia." Archives of Internal Medicine, vol. 164, no. 6, 2004, pp. 637-44.
Houck PM, Bratzler DW, Nsa W, et al. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med. 2004;164(6):637-44.
Houck, P. M., Bratzler, D. W., Nsa, W., Ma, A., & Bartlett, J. G. (2004). Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Archives of Internal Medicine, 164(6), 637-44.
Houck PM, et al. Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-acquired Pneumonia. Arch Intern Med. 2004 Mar 22;164(6):637-44. PubMed PMID: 15037492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. AU - Houck,Peter M, AU - Bratzler,Dale W, AU - Nsa,Wato, AU - Ma,Allen, AU - Bartlett,John G, PY - 2004/3/24/pubmed PY - 2004/4/23/medline PY - 2004/3/24/entrez SP - 637 EP - 44 JF - Archives of internal medicine JO - Arch Intern Med VL - 164 IS - 6 N2 - BACKGROUND: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital. METHODS: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS). RESULTS: Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics. CONCLUSIONS: Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15037492/Timing_of_antibiotic_administration_and_outcomes_for_Medicare_patients_hospitalized_with_community_acquired_pneumonia_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.6.637 DB - PRIME DP - Unbound Medicine ER -