Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia - PubMed (original) (raw)
Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia
Eric M Mortensen et al. Am J Med. 2004.
Abstract
Purpose: National practice guidelines have recommended specific initial empiric antimicrobial regimens for patients with community-acquired pneumonia. Our aim was to determine the association between the use of guideline-concordant antimicrobial therapy and 30-day mortality in patients with pneumonia.
Methods: We conducted a retrospective cohort study at two tertiary teaching hospitals. Eligible patients were admitted with a diagnosis of community-acquired pneumonia, had a chest radiograph consistent with pneumonia, and had a discharge diagnosis of pneumonia. All eligible patients were identified and a random sample was abstracted. We determined whether the use of guideline-concordant antibiotics was associated with 30-day mortality in an analysis that adjusted for potential confounders using propensity scores.
Results: Information was obtained on 420 patients with pneumonia. The mean (+/- SD) age was 63 +/- 16 years, 355 were men, and 82 patients were initially admitted to the intensive care unit. At 30 days after presentation, 41 patients (9.8%) had died: 21 of 97 (21.7%) in the non-guideline-concordant group and 20 of 323 (6.2%) in the guideline-concordant group. Antibiotics were concordant with national guidelines in 323 patients. In the regression analysis, after adjustment for the propensity score, failure to comply with antimicrobial therapy guidelines was associated with increased 30-day mortality (odds ratio = 5.7; 95% confidence interval: 2.0 to 16.0).
Conclusion: Receipt of antimicrobial regimens concordant with national published guidelines may reduce 30-day mortality among patients hospitalized with pneumonia.
Comment in
- Community-acquired pneumonia guidelines: Peering back through the looking glass...clearly?
Peterson MW, Hornick DB. Peterson MW, et al. Am J Med. 2004 Nov 15;117(10):799-800. doi: 10.1016/j.amjmed.2004.09.005. Am J Med. 2004. PMID: 15541330 No abstract available.
Similar articles
- Antibiotic therapy and 48-hour mortality for patients with pneumonia.
Mortensen EM, Restrepo MI, Anzueto A, Pugh JA. Mortensen EM, et al. Am J Med. 2006 Oct;119(10):859-64. doi: 10.1016/j.amjmed.2006.04.017. Am J Med. 2006. PMID: 17000217 - Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit.
Frei CR, Attridge RT, Mortensen EM, Restrepo MI, Yu Y, Oramasionwu CU, Ruiz JL, Burgess DS. Frei CR, et al. Clin Ther. 2010 Feb;32(2):293-9. doi: 10.1016/j.clinthera.2010.02.006. Clin Ther. 2010. PMID: 20206787 - Impact of guideline-concordant empiric antibiotic therapy in community-acquired pneumonia.
Frei CR, Restrepo MI, Mortensen EM, Burgess DS. Frei CR, et al. Am J Med. 2006 Oct;119(10):865-71. doi: 10.1016/j.amjmed.2006.02.014. Am J Med. 2006. PMID: 17000218 - Evidence-based emergency medicine/critically appraised topic. Evidence behind the 4-hour rule for initiation of antibiotic therapy in community-acquired pneumonia.
Yu KT, Wyer PC. Yu KT, et al. Ann Emerg Med. 2008 May;51(5):651-62, 662.e1-2. doi: 10.1016/j.annemergmed.2007.10.022. Epub 2008 Feb 13. Ann Emerg Med. 2008. PMID: 18272253 Review. - [Optimizing the antibiotics policy in The Netherlands. VIII. Revised SWAB guidelines for antimicrobial therapy in adults with community-acquired pneumonia].
Schouten JA, Prins JM, Bonten M, Degener JE, Janknegt R, Hollander JM, Jonkers R, Wijnands W, Verheij T, Sachs A, Kullberg BJ. Schouten JA, et al. Ned Tijdschr Geneeskd. 2005 Nov 5;149(45):2495-500. Ned Tijdschr Geneeskd. 2005. PMID: 16304886 Review. Dutch.
Cited by
- Acute organ injury and long-term sequelae of severe pneumococcal infections.
Kruckow KL, Zhao K, Bowdish DME, Orihuela CJ. Kruckow KL, et al. Pneumonia (Nathan). 2023 Mar 5;15(1):5. doi: 10.1186/s41479-023-00110-y. Pneumonia (Nathan). 2023. PMID: 36870980 Free PMC article. Review. - C/MIC > 4: A Potential Instrument to Predict the Efficacy of Meropenem.
Zhao Y, Xiao C, Hou J, Wu J, Xiao Y, Zhang B, Sandaradura I, Luo H, Li J, Yan M. Zhao Y, et al. Antibiotics (Basel). 2022 May 16;11(5):670. doi: 10.3390/antibiotics11050670. Antibiotics (Basel). 2022. PMID: 35625314 Free PMC article. - Effectiveness of Beta-Lactam plus Doxycycline for Patients Hospitalized with Community-Acquired Pneumonia.
Uddin M, Mohammed T, Metersky M, Anzueto A, Alvarez CA, Mortensen EM. Uddin M, et al. Clin Infect Dis. 2022 Aug 24;75(1):118-124. doi: 10.1093/cid/ciab863. Clin Infect Dis. 2022. PMID: 34751745 Free PMC article. - Initial diagnosis and management of adult community-acquired pneumonia: a 5-day prospective study in Shanghai.
Hu WP, Zhang FY, Zhang J, Hang JQ, Zeng YY, Du CL, Jie ZJ, Jin XY, Zheng CX, Luo XM, Huang Y, Cheng QJ, Qu JM. Hu WP, et al. J Thorac Dis. 2020 Apr;12(4):1417-1426. doi: 10.21037/jtd.2020.03.02. J Thorac Dis. 2020. PMID: 32395279 Free PMC article. - The REMAP-CAP (Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia) Study. Rationale and Design.
Angus DC, Berry S, Lewis RJ, Al-Beidh F, Arabi Y, van Bentum-Puijk W, Bhimani Z, Bonten M, Broglio K, Brunkhorst F, Cheng AC, Chiche JD, De Jong M, Detry M, Goossens H, Gordon A, Green C, Higgins AM, Hullegie SJ, Kruger P, Lamontagne F, Litton E, Marshall J, McGlothlin A, McGuinness S, Mouncey P, Murthy S, Nichol A, O'Neill GK, Parke R, Parker J, Rohde G, Rowan K, Turner A, Young P, Derde L, McArthur C, Webb SA. Angus DC, et al. Ann Am Thorac Soc. 2020 Jul;17(7):879-891. doi: 10.1513/AnnalsATS.202003-192SD. Ann Am Thorac Soc. 2020. PMID: 32267771 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical