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Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission.
Respir Med. 2007 Sep; 101(9):1909-15.RM

Abstract

OBJECTIVE

To evaluate adherence to guidelines when choosing an empirical treatment and its impact upon the prognosis of community-acquired pneumonia (CAP).

METHODS

A prospective multicentre study was conducted in 425 CAP patients hospitalized on ward. Initial empirical treatment was classified as adhering or not to Spanish guidelines. Adherent treatment was defined as an initial antimicrobial regimen consisting of beta-lactams plus macrolides, beta-lactam monotherapy and quinolones. Non-adherent treatments included macrolide monotherapy and other regimens. Initial severity was graded according to pneumonia severity index (PSI). The end point variables were mortality, length of stay (LOS) and re-admission at 30 days.

RESULTS

Overall 30-day mortality was 8.2%, the mean LOS was 8+/-5 days, and the global re-admission rate was 7.6%. Adherence to guidelines was 76.5%, and in most cases the empirical treatment consisted of beta-lactam and macrolide in combination (57.4%). Logistic regression analysis showed that other regimens were associated with higher mortality OR=3 (1.2-7.3), after adjusting for PSI and admitting hospital. Beta-lactam monotherapy was an independent risk factor for re-admission. LOS was independently associated with admitting hospital and not with antibiotics.

CONCLUSIONS

A high adherence to CAP treatment guidelines was found, though with considerable variability in the empirical antibiotic treatment among hospitals. Non-adherent other regimens were associated with greater mortality. Beta-lactam monotherapy was associated with an increased re-admission rate.

Authors+Show Affiliations

Service of Pneumology, Hospital Universitario La Fe, Valencia, Spain. reyes@comv.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17628462

Citation

Reyes Calzada, S, et al. "Empiric Treatment in Hospitalized Community-acquired Pneumonia. Impact On Mortality, Length of Stay and Re-admission." Respiratory Medicine, vol. 101, no. 9, 2007, pp. 1909-15.
Reyes Calzada S, Martínez Tomas R, Cremades Romero MJ, et al. Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission. Respir Med. 2007;101(9):1909-15.
Reyes Calzada, S., Martínez Tomas, R., Cremades Romero, M. J., Martínez Moragón, E., Soler Cataluña, J. J., & Menéndez Villanueva, R. (2007). Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission. Respiratory Medicine, 101(9), 1909-15.
Reyes Calzada S, et al. Empiric Treatment in Hospitalized Community-acquired Pneumonia. Impact On Mortality, Length of Stay and Re-admission. Respir Med. 2007;101(9):1909-15. PubMed PMID: 17628462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Empiric treatment in hospitalized community-acquired pneumonia. Impact on mortality, length of stay and re-admission. AU - Reyes Calzada,S, AU - Martínez Tomas,R, AU - Cremades Romero,M J, AU - Martínez Moragón,E, AU - Soler Cataluña,J J, AU - Menéndez Villanueva,R, Y1 - 2007/07/12/ PY - 2006/10/17/received PY - 2007/03/27/revised PY - 2007/04/23/accepted PY - 2007/7/14/pubmed PY - 2007/11/10/medline PY - 2007/7/14/entrez SP - 1909 EP - 15 JF - Respiratory medicine JO - Respir Med VL - 101 IS - 9 N2 - OBJECTIVE: To evaluate adherence to guidelines when choosing an empirical treatment and its impact upon the prognosis of community-acquired pneumonia (CAP). METHODS: A prospective multicentre study was conducted in 425 CAP patients hospitalized on ward. Initial empirical treatment was classified as adhering or not to Spanish guidelines. Adherent treatment was defined as an initial antimicrobial regimen consisting of beta-lactams plus macrolides, beta-lactam monotherapy and quinolones. Non-adherent treatments included macrolide monotherapy and other regimens. Initial severity was graded according to pneumonia severity index (PSI). The end point variables were mortality, length of stay (LOS) and re-admission at 30 days. RESULTS: Overall 30-day mortality was 8.2%, the mean LOS was 8+/-5 days, and the global re-admission rate was 7.6%. Adherence to guidelines was 76.5%, and in most cases the empirical treatment consisted of beta-lactam and macrolide in combination (57.4%). Logistic regression analysis showed that other regimens were associated with higher mortality OR=3 (1.2-7.3), after adjusting for PSI and admitting hospital. Beta-lactam monotherapy was an independent risk factor for re-admission. LOS was independently associated with admitting hospital and not with antibiotics. CONCLUSIONS: A high adherence to CAP treatment guidelines was found, though with considerable variability in the empirical antibiotic treatment among hospitals. Non-adherent other regimens were associated with greater mortality. Beta-lactam monotherapy was associated with an increased re-admission rate. SN - 0954-6111 UR - https://www.unboundmedicine.com/medline/citation/17628462/Empiric_treatment_in_hospitalized_community_acquired_pneumonia__Impact_on_mortality_length_of_stay_and_re_admission_ DB - PRIME DP - Unbound Medicine ER -