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Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes.
J Crit Care. 2016 12; 36:265-271.JC

Abstract

PURPOSE

Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP.

MATERIALS AND METHODS

We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model.

RESULTS

A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). Patients receiving GC-HCAP had higher 30-day patient mortality compared to GC-CAP patients (34% vs 22%; P< .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (odds ratio, 1.67; 95% confidence interval, 1.30-2.13), recent hospital admission (1.53; 1.15-2.02), and receipt of GC-HCAP therapy (1.51; 1.20-1.90).

CONCLUSIONS

Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.

Authors+Show Affiliations

Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209; Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229. Electronic address: attridge@uiwtx.edu.College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: freic@uthscsa.edu.Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: pughm@uthscsa.edu.College of Pharmacy, The University of Texas at Austin, Austin, TX 78712. Electronic address: ken.lawson@austin.utexas.edu.College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: ryanl@uthscsa.edu.Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: anzueto@uthscsa.edu.University of Connecticut School of Medicine, Farmington, CT 06030. Electronic address: Metersky@nso.uchc.edu.Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: restrepom@uthscsa.edu.Section of General Internal Medicine, VA North Texas Health Care System, Dallas, TX 75216; Division of General Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390. Electronic address: eric.mortensen@utsouthwestern.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27595461

Citation

Attridge, Russell T., et al. "Health Care-associated Pneumonia in the Intensive Care Unit: Guideline-concordant Antibiotics and Outcomes." Journal of Critical Care, vol. 36, 2016, pp. 265-271.
Attridge RT, Frei CR, Pugh MJ, et al. Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. J Crit Care. 2016;36:265-271.
Attridge, R. T., Frei, C. R., Pugh, M. J., Lawson, K. A., Ryan, L., Anzueto, A., Metersky, M. L., Restrepo, M. I., & Mortensen, E. M. (2016). Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. Journal of Critical Care, 36, 265-271. https://doi.org/10.1016/j.jcrc.2016.08.004
Attridge RT, et al. Health Care-associated Pneumonia in the Intensive Care Unit: Guideline-concordant Antibiotics and Outcomes. J Crit Care. 2016;36:265-271. PubMed PMID: 27595461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes. AU - Attridge,Russell T, AU - Frei,Christopher R, AU - Pugh,Mary Jo V, AU - Lawson,Kenneth A, AU - Ryan,Laurajo, AU - Anzueto,Antonio, AU - Metersky,Mark L, AU - Restrepo,Marcos I, AU - Mortensen,Eric M, Y1 - 2016/08/11/ PY - 2016/05/16/received PY - 2016/07/23/revised PY - 2016/08/04/accepted PY - 2016/11/5/pubmed PY - 2017/9/29/medline PY - 2016/9/6/entrez KW - Antibiotic therapy KW - Critical care KW - Guideline-concordant therapy KW - Health outcomes KW - Pneumonia SP - 265 EP - 271 JF - Journal of critical care JO - J Crit Care VL - 36 N2 - PURPOSE: Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP. MATERIALS AND METHODS: We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model. RESULTS: A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). Patients receiving GC-HCAP had higher 30-day patient mortality compared to GC-CAP patients (34% vs 22%; P< .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (odds ratio, 1.67; 95% confidence interval, 1.30-2.13), recent hospital admission (1.53; 1.15-2.02), and receipt of GC-HCAP therapy (1.51; 1.20-1.90). CONCLUSIONS: Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/27595461/Health_care_associated_pneumonia_in_the_intensive_care_unit:_Guideline_concordant_antibiotics_and_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(16)30324-0 DB - PRIME DP - Unbound Medicine ER -