Antimicrobial Selection for Hospitalized Patients with Presumed Community-Acquired Pneumonia: A Survey of Nonteaching US Community Hospitals

Dudas, Vicky; Hopefl, Alan W.; Jacobs, Richard A.; Guglielmo, B. Joseph

doi:10.1345/aph.19174

Cited by 112 publications

(71 citation statements)

References 11 publications

(2 reference statements)

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“…However, this variable was not subsequently selected in the multivariate model. Previous studies that analysed the influence of treatment on the duration of hospitalisation obtained discordant results [29,30]. Adherence, or not, to the SEPAR guidelines for the treatment of CAP did not relate significantly with LOS, as has been reported previously by the authors [31] and others [32].…”

Section: Discussionmentioning

confidence: 53%

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Menéndez¹,

Cremades²,

Martínez‐Moragón³

et al. 2003

Eur Respir J

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Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation.Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens.The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals.Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V. Eur Respir J 2003; 22: 643-648. Community-acquired pneumonia (CAP) is the cause of hospitalisation for 3-5 per 1000 adults per year and with a mortality rate of 5-15%. Pneumonia is the infectious disease with the highest health costs [1][2][3][4] and, since approximately one-third of all patients with CAP are treated in hospital, the resulting costs constitute a significant part of the overall direct costs of infectious diseases [5][6][7]. The most important component of these costs is the length of stay (LOS) in hospital and estimates indicate these costs to be higher than those of the diagnostic tests involved and the subsequent antimicrobial treatments administered [6].There is considerable variability in LOS between hospitals. Reported findings are discordant and depend on the types of hospital in which the different studies had been conducted [8][9][10][11]. The differences might reflect variations in clinical practice preferences, hospital characteristics and patient characteristics and attitudes. Over recent years the LOS appears to have decreased from 9 to 6 days [12, 13] as a result of several strategies and practical guidelines that have been proposed in order to safely reduce the number of hospitalisation days [14].The LOS is influenced by several clinical factors, such as the Pneumonia Severity Index (PSI) [15] associated comorbidit...

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Section: Discussionmentioning

confidence: 53%

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Menéndez¹,

Cremades²,

Martínez‐Moragón³

et al. 2003

Eur Respir J

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“…Although some earlier studies did not find differences in mortality according to compliance, 21 later reports found a higher mortality, even after adjusting for initial severity, when the treatment used did not comply with the guidelines. [22][23][24][25] However, on multivariate analysis, only initial treatment with quinolones (levofloxacin 89.5%) was independently associated with lower treatment failure, although this effect disappeared when early or late failure was analysed. The newer fluoroquinolones may have contributed to our findings because of their potency, broad spectrum covering S pneumoniae and atypical micro-organisms, and favourable phamacokinetics.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Menéndez

Torres²,

Zalacaín³

et al. 2004

Thorax

276

235

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“…Treatment consistent with the ATS guidelines [27], for example, in which macrolides are recommended for atypical coverage, has been shown to significantly reduce length of hospitalisation as well as mortality from CAP [67,69,70].…”

Section: Community-acquired Pneumoniamentioning

confidence: 96%

“…A number of studies have shown that adherence to guidelines for empirical prescribing in CAP results in significant improvement in clinical outcome [67][68][69][70][71]. Treatment consistent with the ATS guidelines [27], for example, in which macrolides are recommended for atypical coverage, has been shown to significantly reduce length of hospitalisation as well as mortality from CAP [67,69,70].…”

Section: Community-acquired Pneumoniamentioning

confidence: 99%

Atypical pathogens and respiratory tract infections

Blasi¹

2004

European Respiratory Journal

109

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The atypical respiratory pathogens Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila are now recognised as a significant cause of acute respiratory-tract infections, implicated in community-acquired pneumonia, acute exacerbations of chronic bronchitis, asthma, and less frequently, upper respiratory-tract infections.Chronic infection with C. pneumoniae is common among patients with chronic obstructive pulmonary disease and may also play a role in the natural history of asthma, including exacerbations. The lack of a gold standard for diagnosis of these pathogens still handicaps the current understanding of their true prevalence and role in the pathogenesis of acute and chronic respiratory infections.While molecular diagnostic techniques, such as polymerase chain reaction, offer improvements in sensitivity, specificity and rapidity over culture and serology, the need remains for a consistent and reproducible diagnostic technique, available to all microbiology laboratories.Current treatment guidelines for community-acquired pneumonia recognise the importance of atypical respiratory pathogens in its aetiology, for which macrolides are considered suitable first-line agents. The value of atypical coverage in antibiotic therapy for acute exacerbations of chronic bronchitis and exacerbations of asthma is less clear, while there is no evidence to suggest that atypical pathogens should be covered in antibiotic treatment of upper respiratory-tract infections. The term "atypical pathogen" most commonly refers to Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila. Once believed to be of little clinical significance, a wealth of data accumulated over the past decade suggests that these are important respiratory pathogens in a wide range of respiratory-tract infections (RTIs) and are capable of causing severe, as well as mild-to-moderate, illness.Although the role of atypical pathogens [1], and of C. pneumoniae in particular [2], has been reviewed previously, there has been little focus on appropriate coverage of these pathogens in treatment decisions for patients with RTIs. In addressing this issue, this review examines the role of atypical pathogens in the aetiology of upper and lower RTIs, in both adults and children, and discusses the value of appropriate coverage of these pathogens in empirical antibiotic prescribing.

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Antimicrobial Selection for Hospitalized Patients with Presumed Community-Acquired Pneumonia: A Survey of Nonteaching US Community Hospitals

Abstract: Most hospitalized patients with CAP receive antimicrobial therapy consistent with the ATS guidelines. The addition of a macrolide may be associated with improved patient outcomes.

Cited by 112 publications

References 11 publications

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Atypical pathogens and respiratory tract infections

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