[Antibiotic treatment onset delay and clinical evolution in admitted patients with community-acquired pneumonia]

The delay in the initiation of antibiotic treatment in patients with community-acquired pneumonia (CAP) could influence their prognostic. The aim of our study was to evaluate the influence of a delay in antibiotic treatment on mortality, occurrence of complications, and length of stay in the hospital, in relation to the prior duration of the fever.

This is a cohort study which includes all patients over 18 years of age admitted with CAP over a 4 year period. The response variables analysed were in-hospital mortality, average stay in days and occurrence of complications during evolution. The relationship between the delay in antibiotic treatment and the outcome variables was estimated by logistic regression models, adjusting the estimations by PSI (Pneumonia Severity Index) and APACHE II (Acute Physiology and Chronic Health Evaluation).

Six hundred fifty-nine patients were included (average age of 71 years, 71% males). Seventy-six (11.6%) patients died, 12.1% of those who arrived after 48 hours (55.4% of patients) and 10.9% of those who came early. The delay in antibiotic treatment was associated with a higher mortality (odds ratio [OR] = 3.05; 95% confidence interval [CI], 0.86-10.9; threshold of 8 h), prolonged stay (OR = 2.38; CI 95%, 1.11-5.14; threshold of 5 h) and a higher rate of complications (OR = 2.24; CI 95%, 0.90-5.53; threshold of 3 h).

Our results suggest the importance of the early administration of antibiotics in patients with CAP. There is also an increased risk for each of these outcomes in those patients with a history of fever of more than 2 days before arriving in hospital.