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Atypical coverage in community-acquired pneumonia after outpatient beta-lactam monotherapy

Cornelis H van Werkhoven1, Ewoudt M W van de Garde2, Jan Jelrik Oosterheert3

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Respiratory Medicine
|July 23, 2017
PubMed
Abstract

Insights

For hospitalized community-acquired pneumonia (CAP) patients on outpatient beta-lactam monotherapy, adding atypical coverage did not reduce hospital stay or mortality but may increase treatment escalations. Further research is needed.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Clinical Pharmacy

Background:

  • Community-acquired pneumonia (CAP) management guidelines often recommend atypical pathogen coverage.
  • Expert opinion suggests adding atypical coverage for hospitalized CAP patients previously on beta-lactam monotherapy for over 48 hours.

Purpose of the Study:

  • To evaluate the impact of initiating atypical pathogen coverage on clinical outcomes in hospitalized CAP patients.
  • To compare length of hospital stay (LOS), 30-day mortality, and treatment escalations between patients who continued beta-lactam monotherapy versus those who received additional atypical coverage.

Main Methods:

  • Post-hoc analysis of a large community-acquired pneumonia treatment study.
  • Included patients received >48 hours of outpatient beta-lactam monotherapy before hospitalization.
  • Compared outcomes (LOS, mortality, treatment escalations) for patients continuing beta-lactam monotherapy versus those receiving atypical coverage upon admission.

Main Results:

  • Of 179 patients, 131 (73%) received additional atypical coverage.
  • Crude analysis showed no significant difference in median LOS (6 days) or 30-day mortality (2% vs. 4%).
  • Adjusted analysis indicated no increased LOS or mortality with absence of atypical coverage, but a trend towards more treatment escalations (adjusted effect ratio 2.75).

Conclusions:

  • In hospitalized CAP patients with prior beta-lactam monotherapy, initiating atypical coverage did not improve LOS or mortality.
  • Absence of atypical coverage was associated with a trend towards more treatment escalations.
  • Current expert opinion on adding atypical coverage in this scenario warrants re-evaluation.
Keywords:
AntibioticsAtypical pathogensCommunity-acquired pneumoniaEmpirical treatmentTreatment escalation

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