Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH

Abstract

BackgroundData describing real-life management and treatment of community-acquired pneumonia (CAP) in Europe are limited. REACH (http://NCT01293435) was a retrospective, observational study collecting data on the management of EU patients hospitalized with CAP.The purpose of this study was to understand patient and disease characteristics in patients hospitalized with CAP and to review current clinical practices and outcomes.MethodsPatients were aged ≥18 years, hospitalized with CAP between March 2010 and February 2011, and requiring in-hospital treatment with intravenous antibiotics. An electronic Case Report Form was used to collect patient, disease and treatment variables, including type of CAP, medical history, treatment setting, antibiotics administered and clinical outcomes.ResultsPatients (N = 2,039) were recruited from 128 centres in ten EU countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Turkey, UK). The majority of patients were aged ≥65 years (56.4%) and had CAP only (78.8%). Initial antibiotic treatment modification occurred in 28.9% of patients and was more likely in certain groups (patients with comorbidities; more severely ill patients; patients with healthcare-associated pneumonia, immunosuppression or recurrent episodes of CAP). Streamlining (de-escalation) of therapy occurred in 5.1% of patients. Mean length of hospital stay was 12.6 days and overall mortality was 7.2%.ConclusionThese data provide a current overview of clinical practice in patients with CAP in EU hospitals, revealing high rates of initial antibiotic treatment modification. The findings may precipitate reassessment of optimal management regimens for hospitalized CAP patients.

Epidemiology, microbiology and treatment implications in adult patients hospitalized with pneumonia in different regions of China: a retrospective study

“…The average length of stay was considerably longer at Peking University People's Hospital (approximately 21 days) than at Guangdong Provincial Hospital of TCM (approximately 12 days). Overall, the length of stay across both sites was higher than that reported in a large European epidemiology study (12.6 days) (28). There was a higher frequency of initial antibiotic modification in Beijing (60%) than in Guangdong (43%), which may reflect differences in disease severity, but both were considerably higher than that reported in a similar observational study of hospitalised CAP patients in Europe (29%) (28).…”

“…Overall, the length of stay across both sites was higher than that reported in a large European epidemiology study (12.6 days) (28). There was a higher frequency of initial antibiotic modification in Beijing (60%) than in Guangdong (43%), which may reflect differences in disease severity, but both were considerably higher than that reported in a similar observational study of hospitalised CAP patients in Europe (29%) (28). However, it is important to note that empiric therapy was only modified if patients later received a microbiological diagnosis and/ or the initial treatment was not effective, and in the current study the modifications were mostly de-escalations of antibiotic therapy based on microbiology test results.…”

“…S. aureus is recognized as an important cause of both HAP and CAP (28). The proportion of MRSA among S. aureus isolates was higher in Beijing (75%) as compared with Guangdong (56%).…”

Community-acquired pneumonia

“…A review of 46 studies conducted from 11 European countries between 1990 and 2007 found that the mortality among inpatients and outpatients with CAP ranged from 4 to 48% [2]. Furthermore, although recent studies of hospitalized patients with CAP from Europe, Thailand, US/Canada, Europe and Latin America identified mortality rates ranging from of 7.2, 9.6, 13.3, 9.1 and 7.3%, respectively [30][31][32], a large multicentre audit of 16 313 hospitalized CAP patients from the UK found a frighteningly high 30-day mortality rate of 18.5% [33]. These differences in mortality between regions and studies remain unexplained; they are likely to be related largely to case mix with mortality increased in the elderly and patients with comorbidities.…”

Profile and management of community acquired pneumonia in a tertiary care hospital in Karachi

“…Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License required hospitalization (Blasi et al, 2013). In United States of America, the frequency of CAP is around 3 to 5 cases per 1000 individuals with mortality of 5.0 to 15.0% which were hospitalized.…”