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Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia.
Am J Med. 2004 Nov 15; 117(10):726-31.AJ

Abstract

PURPOSE

National practice guidelines have recommended specific initial empiric antimicrobial regimens for patients with community-acquired pneumonia. Our aim was to determine the association between the use of guideline-concordant antimicrobial therapy and 30-day mortality in patients with pneumonia.

METHODS

We conducted a retrospective cohort study at two tertiary teaching hospitals. Eligible patients were admitted with a diagnosis of community-acquired pneumonia, had a chest radiograph consistent with pneumonia, and had a discharge diagnosis of pneumonia. All eligible patients were identified and a random sample was abstracted. We determined whether the use of guideline-concordant antibiotics was associated with 30-day mortality in an analysis that adjusted for potential confounders using propensity scores.

RESULTS

Information was obtained on 420 patients with pneumonia. The mean (+/- SD) age was 63 +/- 16 years, 355 were men, and 82 patients were initially admitted to the intensive care unit. At 30 days after presentation, 41 patients (9.8%) had died: 21 of 97 (21.7%) in the non-guideline-concordant group and 20 of 323 (6.2%) in the guideline-concordant group. Antibiotics were concordant with national guidelines in 323 patients. In the regression analysis, after adjustment for the propensity score, failure to comply with antimicrobial therapy guidelines was associated with increased 30-day mortality (odds ratio = 5.7; 95% confidence interval: 2.0 to 16.0).

CONCLUSION

Receipt of antimicrobial regimens concordant with national published guidelines may reduce 30-day mortality among patients hospitalized with pneumonia.

Authors+Show Affiliations

Division of General Internal Medicine, Veterans Evidence-Based Research Dissemination and Implementation Center, and South Texas Veterans Health Care System, San Antonio, Texas 78284, USA. mortensen@verdict.uthscsa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

15541321

Citation

Mortensen, Eric M., et al. "Effects of Guideline-concordant Antimicrobial Therapy On Mortality Among Patients With Community-acquired Pneumonia." The American Journal of Medicine, vol. 117, no. 10, 2004, pp. 726-31.
Mortensen EM, Restrepo M, Anzueto A, et al. Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am J Med. 2004;117(10):726-31.
Mortensen, E. M., Restrepo, M., Anzueto, A., & Pugh, J. (2004). Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. The American Journal of Medicine, 117(10), 726-31.
Mortensen EM, et al. Effects of Guideline-concordant Antimicrobial Therapy On Mortality Among Patients With Community-acquired Pneumonia. Am J Med. 2004 Nov 15;117(10):726-31. PubMed PMID: 15541321.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. AU - Mortensen,Eric M, AU - Restrepo,Marcos, AU - Anzueto,Antonio, AU - Pugh,Jacqueline, PY - 2003/08/21/received PY - 2004/06/13/accepted PY - 2004/11/16/pubmed PY - 2004/12/24/medline PY - 2004/11/16/entrez SP - 726 EP - 31 JF - The American journal of medicine JO - Am J Med VL - 117 IS - 10 N2 - PURPOSE: National practice guidelines have recommended specific initial empiric antimicrobial regimens for patients with community-acquired pneumonia. Our aim was to determine the association between the use of guideline-concordant antimicrobial therapy and 30-day mortality in patients with pneumonia. METHODS: We conducted a retrospective cohort study at two tertiary teaching hospitals. Eligible patients were admitted with a diagnosis of community-acquired pneumonia, had a chest radiograph consistent with pneumonia, and had a discharge diagnosis of pneumonia. All eligible patients were identified and a random sample was abstracted. We determined whether the use of guideline-concordant antibiotics was associated with 30-day mortality in an analysis that adjusted for potential confounders using propensity scores. RESULTS: Information was obtained on 420 patients with pneumonia. The mean (+/- SD) age was 63 +/- 16 years, 355 were men, and 82 patients were initially admitted to the intensive care unit. At 30 days after presentation, 41 patients (9.8%) had died: 21 of 97 (21.7%) in the non-guideline-concordant group and 20 of 323 (6.2%) in the guideline-concordant group. Antibiotics were concordant with national guidelines in 323 patients. In the regression analysis, after adjustment for the propensity score, failure to comply with antimicrobial therapy guidelines was associated with increased 30-day mortality (odds ratio = 5.7; 95% confidence interval: 2.0 to 16.0). CONCLUSION: Receipt of antimicrobial regimens concordant with national published guidelines may reduce 30-day mortality among patients hospitalized with pneumonia. SN - 0002-9343 UR - https://www.unboundmedicine.com/medline/citation/15541321/Effects_of_guideline_concordant_antimicrobial_therapy_on_mortality_among_patients_with_community_acquired_pneumonia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(04)00522-4 DB - PRIME DP - Unbound Medicine ER -