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Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia.
J Am Geriatr Soc. 2009 Jun; 57(6):1030-5.JA

Abstract

OBJECTIVES

To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia.

DESIGN

Retrospective study.

SETTING

Three tertiary-care hospitals.

PARTICIPANTS

Three hundred thirty-four nursing home patients.

MEASUREMENTS

Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups.

RESULTS

Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (P=.006) and multilobar involvement (P=.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49-1.34, and OR=0.79, 95% CI=0.42-1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline.

CONCLUSION

In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline.

Authors+Show Affiliations

Veterans Affairs Western New York Healthcare System, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY 14215, USA. solh@buffalo.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19460091

Citation

El Solh, Ali A., et al. "Effect of Antibiotic Guidelines On Outcomes of Hospitalized Patients With Nursing Home-acquired Pneumonia." Journal of the American Geriatrics Society, vol. 57, no. 6, 2009, pp. 1030-5.
El Solh AA, Akinnusi ME, Alfarah Z, et al. Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia. J Am Geriatr Soc. 2009;57(6):1030-5.
El Solh, A. A., Akinnusi, M. E., Alfarah, Z., & Patel, A. (2009). Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia. Journal of the American Geriatrics Society, 57(6), 1030-5. https://doi.org/10.1111/j.1532-5415.2009.02279.x
El Solh AA, et al. Effect of Antibiotic Guidelines On Outcomes of Hospitalized Patients With Nursing Home-acquired Pneumonia. J Am Geriatr Soc. 2009;57(6):1030-5. PubMed PMID: 19460091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia. AU - El Solh,Ali A, AU - Akinnusi,Morohunfolu E, AU - Alfarah,Ziad, AU - Patel,Anil, Y1 - 2009/04/30/ PY - 2009/5/23/entrez PY - 2009/5/23/pubmed PY - 2009/6/20/medline SP - 1030 EP - 5 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 57 IS - 6 N2 - OBJECTIVES: To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia. DESIGN: Retrospective study. SETTING: Three tertiary-care hospitals. PARTICIPANTS: Three hundred thirty-four nursing home patients. MEASUREMENTS: Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups. RESULTS: Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (P=.006) and multilobar involvement (P=.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49-1.34, and OR=0.79, 95% CI=0.42-1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline. CONCLUSION: In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/19460091/Effect_of_antibiotic_guidelines_on_outcomes_of_hospitalized_patients_with_nursing_home_acquired_pneumonia_ L2 - https://doi.org/10.1111/j.1532-5415.2009.02279.x DB - PRIME DP - Unbound Medicine ER -