Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

Madaras‐Kelly, Karl; Remington, Richard; Sloan, Kevin L.; Fan, Vincent S.

doi:10.1007/s11606-012-2011-y

Cited by 23 publications

(20 citation statements)

References 25 publications

(30 reference statements)

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“…By limiting our cohort to ICU patients, we expected that restrictions on care would have a smaller role, and that GC-HCAP antibiotics might be more likely to be beneficial. Despite this approach, the effects of GC-HCAP therapy remained consistent with prior studies, where GC-HCAP therapy given to patients in the medical ward or mixed ward/ICU patients either increased mortality or had no effect on mortality [5,13–15]. Data using a less strict combination of guideline-similar antibiotics (e.g., one anti-MRSA antibiotic and only one antipseudomonal antibiotic) in mixed ward/ICU cohorts have also demonstrated similar results to our study [15,16].…”

Section: Discussionsupporting

confidence: 65%

Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

Attridge

Frei

Pugh

et al. 2016

Journal of Critical Care

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Purpose Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with healthcare-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an ICU with HCAP. Materials and Methods We performed a population-based cohort study of patients admitted to >150 hospitals in the U.S. Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving either GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model. Results A total of 3,593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). GC-HCAP patients had higher 30-day patient mortality compared to GC-CAP patients (34% vs. 22%, p<0.0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (OR, 95% CI; 1.67, 1.30–2.13), recent hospital admission (1.53, 1.15–2.02), and receipt of GC-HCAP therapy (1.51, 1.20–1.90). Conclusions Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.

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Section: Discussionsupporting

confidence: 65%

Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

Attridge

Frei

Pugh

et al. 2016

Journal of Critical Care

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“…Some authors have found higher mortality rates with the use of guideline-concordant empirical therapy, with a trend toward higher mortality rates even in the subset with MRSA (741,742). A more nuanced view emerged from Madaras-Kelly et al, in which receipt of "guideline-similar therapy" increased the 30-day mortality rate overall but appeared to improve mortality in the subset of patients with an a priori increased risk of resistance to ceftriaxone or moxifloxacin (743).…”

Section: Managementmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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“…[2][3][4][21][22][23][24] It is also not well defined whether HCAP treatment should align with CAP or HAP therapy. [38][39][40][41][42][43][44][45][46] The classification of HCAP was introduced in the 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, 3 which suggested that patients who develop pneumonia in the community and have specific risk factors should be treated similarly to those with HAP, including coverage for MDR pathogens ( Table 2). The frequency of MDR pathogens and whether all MDR risk factors are relevant in all practice settings is unclear and complicate determination of antibiotic recommendations using local data.…”

Section: Pre-intervention Chart Auditmentioning

confidence: 99%

“…The frequency of MDR pathogens and whether all MDR risk factors are relevant in all practice settings is unclear and complicate determination of antibiotic recommendations using local data. [38][39][40][41][42][43][44][45][46] Given limited identification of MDR pathogens in the authors' health region and to prevent the unnecessary use of broad-spectrum antibiotics, the algorithms did not incorporate all MDR risk factors identified by the ATS/IDSA guidelines ( Table 2). The most common MDR pathogens identified in the health region were Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) ( Table 3).…”

Section: Pre-intervention Chart Auditmentioning

confidence: 99%

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

Halpape

Sulz

Schuster

et al. 2014

CJHP

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Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

Cited by 23 publications

References 25 publications

Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

Health care–associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

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