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Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with
P P Gleason1, T P Meehan, J M Fine
1Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, USA.
Background:
Although medical practice guidelines exist, there have been no large-scale studies assessing the relationship between initial antimicrobial therapy and medical outcomes for patients hospitalized with pneumonia.
Objective:
To determine the associations between initial antimicrobial therapy and 30-day mortality for these patients.
Methods:
Hospital records for 12945 Medicare inpatients (> or = 65 years of age) with pneumonia were reviewed. Associations between initial antimicrobial regimens and 30-day mortality were assessed with Cox proportional hazards models, adjusting for baseline differences in patient characteristics, illness severity, and processes of care. Comparisons were made with patients treated with a non-pseudomonal third-generation cephalosporin alone (the reference group).
Results:
Initial treatment with a second-generation cephalosporin plus macrolide (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52-0.96), a non-pseudomonal third-generation cephalosporin plus macrolide (HR, 0.74; 95% CI, 0.60-0.92), or a fluoroquinolone alone (HR, 0.64; 95% CI, 0.43-0.94) was independently associated with lower 30-day mortality. Adjusted mortality among patients initially treated with these 3 regimens became significantly lower than that in the reference group beginning 2, 3, and 7 days, respectively, after hospital admission. Use of a beta-lactam/beta-lactamase inhibitor plus macrolide (HR, 1.77; 95% CI, 1.28-2.46) and an aminoglycoside plus another agent (HR, 1.21; 95% CI, 1.02-1.43) were associated with an increased 30-day mortality.
Conclusions:
In this study of primarily community-dwelling elderly patients hospitalized with pneumonia, 3 initial empiric antimicrobial regimens were independently associated with a lower 30-day mortality. The more widespread use of these antimicrobial regimens is likely to improve the medical outcomes for elderly patients with pneumonia.
Insights
Certain initial antimicrobial therapies significantly reduce 30-day mortality in elderly pneumonia patients. Optimizing antibiotic selection for community-acquired pneumonia can improve patient outcomes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Geriatrics
Background:
- Large-scale studies on initial antimicrobial therapy and outcomes for hospitalized pneumonia patients are lacking.
- Existing medical practice guidelines may not fully reflect real-world effectiveness.
Purpose of the Study:
- To investigate the association between initial antimicrobial regimens and 30-day mortality in elderly patients hospitalized with pneumonia.
- To identify specific antibiotic combinations linked to improved or worsened patient outcomes.
Main Methods:
- Retrospective review of hospital records for 12,945 Medicare inpatients aged 65 years and older with pneumonia.
- Cox proportional hazards models were used to assess associations between initial antimicrobial therapy and 30-day mortality, adjusting for patient characteristics, illness severity, and care processes.
- Comparisons were made against a reference group treated with a non-pseudomonal third-generation cephalosporin alone.
Main Results:
- Initial treatment with a second-generation cephalosporin plus macrolide, a non-pseudomonal third-generation cephalosporin plus macrolide, or a fluoroquinolone alone was associated with significantly lower 30-day mortality.
- Specific regimens like beta-lactam/beta-lactamase inhibitor plus macrolide and aminoglycoside plus another agent were linked to increased 30-day mortality.
- The benefits of the effective regimens became apparent within 2 to 7 days of hospital admission.
Conclusions:
- Three initial empiric antimicrobial regimens demonstrated an independent association with reduced 30-day mortality in elderly patients hospitalized with pneumonia.
- Wider adoption of these effective antimicrobial strategies could lead to better medical outcomes for this patient population.
- The findings support evidence-based antimicrobial stewardship for community-acquired pneumonia in older adults.