Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study

Falcone, Marco; Corrao, Salvatore; Licata, Giuseppe; Serra, Pietro; Venditti, Mario

doi:10.1007/s11739-012-0795-8

Cited by 28 publications

(25 citation statements)

References 26 publications

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“…While several studies on adherence to guidelines of empirical antibiotic therapy for CAP have been conducted in medical wards and intensive care units [6,[13][14][15], a relatively small number of studies have investigated adherence in patients with healthcare-associated pneumonias such as HAP or HCAP [7,[16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Rossio¹,

Franchi²,

Ardoino³

et al. 2015

European Journal of Internal Medicine

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Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

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Section: Discussionmentioning

confidence: 99%

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Rossio¹,

Franchi²,

Ardoino³

et al. 2015

European Journal of Internal Medicine

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“…This result justifies HCAP categorization and the ATS strategy with initially broad-spectrum antibiotic therapy. The Falcone et al study indicates that a broad-spectrum empirical approach may be associated with improved outcome and reduction in the length of hospitalization [16]. …”

Section: Discussionmentioning

confidence: 99%

Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study

et al. 2013

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IntroductionHealth care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified.MethodsWe prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria.ResultsWe included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.ConclusionsFODP mini-BAL was more efficient than blood cultures for identifying pathogens in patients presenting with HCAP. When bacteriological identification was obtained, antibiotic therapy was adapted in 100% of cases.See related letter by Sircar et al.,http://ccforum.com/content/17/2/428

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“…Further, MDR pathogens accounted for 21.3 of non-survivors, which suggests MDR pathogens to be important therapeutic targets to mitigate negative outcomes of HCAP. Falcone et al 26 showed that empirical broad-spectrum therapy was associated with improved outcome in patients with HCAP. However, Attridge et al 27 reported that guideline-concordant HCAP therapy is not associated with improved survival compared with guideline-concordant CAP therapy, in nonsevere HCAP.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

Ishiguro¹,

Takayanagi²,

Gochi³

et al. 2013

Showa Univ J Med Sci

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: Factors contributing to mortality in healthcare-associated pneumonia HCAP have not been investigated fully. We reviewed the etiology and identi ed prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older 73.4 11.4 years , more predominantly male 74.4 , and had more smoking history and comorbidity than did community-acquired pneumonia CAP patients. Microbes were identi ed in 52.8 of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae n 108, 21.6 , influenza virus n 47, 9.4 , and Pseudomonas aeruginosa n 40, 8.0 . Multiple drug-resistant MDR pathogens were more frequent in HCAP patients 9.8 than CAP patients. Overall, 47 HCAP patients 9.4 died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3 of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9 had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, in uenza virus, and P. aeruginosa, in both survivors and nonsurvivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study

Cited by 28 publications

References 26 publications

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Evaluation of early mini-bronchoalveolar lavage in the diagnosis of health care-associated pneumonia: a prospective study

Etiology and Factors Contributing to Mortality in Healthcare-associated Pneumonia: A Single-center Study

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