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Antibiotic therapy and 48-hour mortality for patients with pneumonia.
Am J Med. 2006 Oct; 119(10):859-64.AJ

Abstract

PURPOSE

Although numerous articles have demonstrated that recommended empiric antimicrobial regimens are associated with decreased mortality at 30 days, there is controversy over whether appropriate antibiotic selection has a beneficial impact on mortality within the first 48 to 96 hours after admission. Our aim was to determine whether the use of guideline-concordant antibiotic therapy is associated with decreased mortality within the first 48 hours after admission for patients with pneumonia.

METHODS

A retrospective cohort study was conducted at two tertiary teaching hospitals in San Antonio, Texas. A propensity score was used to balance the covariates associated with the use of guideline-concordant antimicrobial therapy. A multivariable logistic regression model was used to assess the association between mortality within 48 hours and the use of guideline-concordant antibiotic therapy, after adjusting for potential confounders including the propensity score.

RESULTS

Information was obtained on 787 patients with community-acquired pneumonia. The median age was 60 years, 79% were male, and 20% were initially admitted to the intensive care unit. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. Within the first 48 hours, 20 patients died. After adjustment for potential confounders, the use of guideline-concordant antimicrobial therapy (odds ratio 0.37, 95% confidence interval, 0.14-0.95) was significantly associated with decreased mortality at 48 hours after admission.

CONCLUSION

Using initial empiric guideline-concordant antimicrobial therapy is associated with decreased mortality at 48 hours. Further research needs to investigate methods to ensure that patients with community-acquired pneumonia are treated with appropriate antimicrobial therapies.

Authors+Show Affiliations

Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Tex 78284, USA. mortensene@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

17000217

Citation

Mortensen, Eric M., et al. "Antibiotic Therapy and 48-hour Mortality for Patients With Pneumonia." The American Journal of Medicine, vol. 119, no. 10, 2006, pp. 859-64.
Mortensen EM, Restrepo MI, Anzueto A, et al. Antibiotic therapy and 48-hour mortality for patients with pneumonia. Am J Med. 2006;119(10):859-64.
Mortensen, E. M., Restrepo, M. I., Anzueto, A., & Pugh, J. A. (2006). Antibiotic therapy and 48-hour mortality for patients with pneumonia. The American Journal of Medicine, 119(10), 859-64.
Mortensen EM, et al. Antibiotic Therapy and 48-hour Mortality for Patients With Pneumonia. Am J Med. 2006;119(10):859-64. PubMed PMID: 17000217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic therapy and 48-hour mortality for patients with pneumonia. AU - Mortensen,Eric M, AU - Restrepo,Marcos I, AU - Anzueto,Antonio, AU - Pugh,Jacqueline A, PY - 2005/09/27/received PY - 2006/03/27/revised PY - 2006/04/05/accepted PY - 2006/9/27/pubmed PY - 2006/10/7/medline PY - 2006/9/27/entrez SP - 859 EP - 64 JF - The American journal of medicine JO - Am J Med VL - 119 IS - 10 N2 - PURPOSE: Although numerous articles have demonstrated that recommended empiric antimicrobial regimens are associated with decreased mortality at 30 days, there is controversy over whether appropriate antibiotic selection has a beneficial impact on mortality within the first 48 to 96 hours after admission. Our aim was to determine whether the use of guideline-concordant antibiotic therapy is associated with decreased mortality within the first 48 hours after admission for patients with pneumonia. METHODS: A retrospective cohort study was conducted at two tertiary teaching hospitals in San Antonio, Texas. A propensity score was used to balance the covariates associated with the use of guideline-concordant antimicrobial therapy. A multivariable logistic regression model was used to assess the association between mortality within 48 hours and the use of guideline-concordant antibiotic therapy, after adjusting for potential confounders including the propensity score. RESULTS: Information was obtained on 787 patients with community-acquired pneumonia. The median age was 60 years, 79% were male, and 20% were initially admitted to the intensive care unit. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. Within the first 48 hours, 20 patients died. After adjustment for potential confounders, the use of guideline-concordant antimicrobial therapy (odds ratio 0.37, 95% confidence interval, 0.14-0.95) was significantly associated with decreased mortality at 48 hours after admission. CONCLUSION: Using initial empiric guideline-concordant antimicrobial therapy is associated with decreased mortality at 48 hours. Further research needs to investigate methods to ensure that patients with community-acquired pneumonia are treated with appropriate antimicrobial therapies. SN - 1555-7162 UR - https://www.unboundmedicine.com/medline/citation/17000217/Antibiotic_therapy_and_48_hour_mortality_for_patients_with_pneumonia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9343(06)00446-3 DB - PRIME DP - Unbound Medicine ER -