Antibiotic therapy and 48-hour mortality for patients with pneumonia
Eric M Mortensen1, Marcos I Restrepo, Antonio Anzueto
1Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Tex 78284, USA. mortensene@uthscsa.edu
Purpose:
Although numerous articles have demonstrated that recommended empiric antimicrobial regimens are associated with decreased mortality at 30 days, there is controversy over whether appropriate antibiotic selection has a beneficial impact on mortality within the first 48 to 96 hours after admission. Our aim was to determine whether the use of guideline-concordant antibiotic therapy is associated with decreased mortality within the first 48 hours after admission for patients with pneumonia.
Methods:
A retrospective cohort study was conducted at two tertiary teaching hospitals in San Antonio, Texas. A propensity score was used to balance the covariates associated with the use of guideline-concordant antimicrobial therapy. A multivariable logistic regression model was used to assess the association between mortality within 48 hours and the use of guideline-concordant antibiotic therapy, after adjusting for potential confounders including the propensity score.
Results:
Information was obtained on 787 patients with community-acquired pneumonia. The median age was 60 years, 79% were male, and 20% were initially admitted to the intensive care unit. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. Within the first 48 hours, 20 patients died. After adjustment for potential confounders, the use of guideline-concordant antimicrobial therapy (odds ratio 0.37, 95% confidence interval, 0.14-0.95) was significantly associated with decreased mortality at 48 hours after admission.
Conclusion:
Using initial empiric guideline-concordant antimicrobial therapy is associated with decreased mortality at 48 hours. Further research needs to investigate methods to ensure that patients with community-acquired pneumonia are treated with appropriate antimicrobial therapies.
Insights
Guideline-concordant antibiotic therapy for community-acquired pneumonia significantly reduces 48-hour mortality. This finding emphasizes the importance of appropriate empiric antimicrobial selection in early patient management.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Pharmacology
Background:
- Empiric antimicrobial regimens are linked to reduced 30-day mortality in pneumonia.
- Controversy exists regarding the impact of appropriate antibiotic selection on early mortality (48-96 hours).
Purpose of the Study:
- To determine if guideline-concordant antibiotic therapy reduces mortality within 48 hours of admission for pneumonia patients.
Main Methods:
- Retrospective cohort study at two tertiary teaching hospitals.
- Propensity score matching to balance covariates for guideline-concordant therapy.
- Multivariable logistic regression adjusted for confounders and propensity score.
Main Results:
- 787 community-acquired pneumonia patients analyzed.
- Guideline-concordant therapy was associated with significantly decreased 48-hour mortality (OR 0.37, 95% CI 0.14-0.95) after adjustment.
- 20 deaths occurred within 48 hours.
Conclusions:
- Initial empiric guideline-concordant antimicrobial therapy is associated with reduced 48-hour mortality.
- Further research is needed to ensure appropriate antimicrobial treatment for pneumonia.
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