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Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy.
Respirology. 2013 Feb; 18(2):364-8.R

Abstract

BACKGROUND AND OBJECTIVE

Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care-associated pneumonia (HCAP), and thus recommend treatment with broad-spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad-spectrum antibiotics versus narrow-spectrum antibiotics.

METHODS

One hundred twenty-five haemodialysis patients with pneumonia met eligibility criteria. Categorization into the community-acquired pneumonia (CAP) group or HCAP group was based on antibiotic therapy patients received. Time to oral therapy, time to clinical stability, length of stay and mortality were compared.

RESULTS

CAP and HCAP patients did not differ in Pneumonia Severity Index and Charlson Comorbidity index scores, but HCAP patients were more likely to meet criteria for severe pneumonia. Patients treated with HCAP therapy had a significantly longer time to oral therapy than CAP patients (9.2 vs 3.2 days, P < 0.001) and a significantly longer length of stay (11.9 vs 5.1 days, P < 0.001). Time to clinical stability was marginally longer in the HCAP group (3.1 vs 2.4 days, P = 0.07). Patients treated with HCAP therapy had longer continuation of intravenous antibiotics after reaching clinical stability (5.5 vs 0.78 days, P < 0.001).

CONCLUSIONS

This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow-spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de-escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay.

Authors+Show Affiliations

Division of Hospital Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida 33606, USA. spezzo@health.usf.eduNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23066809

Citation

Taylor, Stephanie Parks, and Brice T. Taylor. "Health Care-associated Pneumonia in Haemodialysis Patients: Clinical Outcomes in Patients Treated With Narrow Versus Broad Spectrum Antibiotic Therapy." Respirology (Carlton, Vic.), vol. 18, no. 2, 2013, pp. 364-8.
Taylor SP, Taylor BT. Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy. Respirology. 2013;18(2):364-8.
Taylor, S. P., & Taylor, B. T. (2013). Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy. Respirology (Carlton, Vic.), 18(2), 364-8. https://doi.org/10.1111/j.1440-1843.2012.02306.x
Taylor SP, Taylor BT. Health Care-associated Pneumonia in Haemodialysis Patients: Clinical Outcomes in Patients Treated With Narrow Versus Broad Spectrum Antibiotic Therapy. Respirology. 2013;18(2):364-8. PubMed PMID: 23066809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health care-associated pneumonia in haemodialysis patients: clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy. AU - Taylor,Stephanie Parks, AU - Taylor,Brice T, PY - 2012/10/17/entrez PY - 2012/10/17/pubmed PY - 2013/8/31/medline SP - 364 EP - 8 JF - Respirology (Carlton, Vic.) JO - Respirology VL - 18 IS - 2 N2 - BACKGROUND AND OBJECTIVE: Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care-associated pneumonia (HCAP), and thus recommend treatment with broad-spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad-spectrum antibiotics versus narrow-spectrum antibiotics. METHODS: One hundred twenty-five haemodialysis patients with pneumonia met eligibility criteria. Categorization into the community-acquired pneumonia (CAP) group or HCAP group was based on antibiotic therapy patients received. Time to oral therapy, time to clinical stability, length of stay and mortality were compared. RESULTS: CAP and HCAP patients did not differ in Pneumonia Severity Index and Charlson Comorbidity index scores, but HCAP patients were more likely to meet criteria for severe pneumonia. Patients treated with HCAP therapy had a significantly longer time to oral therapy than CAP patients (9.2 vs 3.2 days, P < 0.001) and a significantly longer length of stay (11.9 vs 5.1 days, P < 0.001). Time to clinical stability was marginally longer in the HCAP group (3.1 vs 2.4 days, P = 0.07). Patients treated with HCAP therapy had longer continuation of intravenous antibiotics after reaching clinical stability (5.5 vs 0.78 days, P < 0.001). CONCLUSIONS: This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow-spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de-escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay. SN - 1440-1843 UR - https://www.unboundmedicine.com/medline/citation/23066809/Health_care_associated_pneumonia_in_haemodialysis_patients:_clinical_outcomes_in_patients_treated_with_narrow_versus_broad_spectrum_antibiotic_therapy_ L2 - https://doi.org/10.1111/j.1440-1843.2012.02306.x DB - PRIME DP - Unbound Medicine ER -