Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study

Shindo, Yuichiro; Ito, Ryo; Kobayashi, Daisuke; Ando, Masahiko; Ichikawa, Motoshi; Gotô, Yasuhiro; Fukui, Yasutaka; Iwaki, Mai; Okumura, Junya; Yamaguchi, Ikuo; Yagi, Tetsuya; Tanikawa, Yoshimasa; Sugino, Yasuteru; Shindoh, Joe; Ogasawara, Tomohiko; Nomura, Fumio; Sasaki, Hideo; Yamamoto, Masashi; Taniguchi, Hiroyuki; Suzuki, Ritsuro; Saitô, Hiroshi; Kawamura, Takashi; Hasegawa, Yoshinori

doi:10.1016/s1473-3099(15)00151-6

Cited by 63 publications

(56 citation statements)

References 33 publications

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“…BUN is included in all four pneumonia severity scores, while Alb is not included. Previous reports showed that low levels of Alb are a poor prognostic factor in CAP [19, 20] and in both CAP and HCAP [21]. Our study also supported these findings, which suggests that, in future, Alb should be included as a prognostic factor in existing pneumonia severity indices.…”

Section: Discussionsupporting

confidence: 90%

Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort

et al. 2017

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BackgroundTo date, only few studies have examined the prognostic factors of community-acquired pneumonia (CAP) defined according to the latest criteria, which excludes healthcare-associated pneumonia (HCAP). Therefore, we aimed to investigate the factors that affect prognosis, and evaluate the usefulness of existing pneumonia severity scores for predicting the prognosis of CAP.MethodsWe retrospectively analyzed patients with CAP, excluding HCAP, who were enrolled prospectively between April 2007 and February 2016. Four patients who used macrolides other than azithromycin (AZM) were excluded. We used age, sex, comorbidities, laboratory findings and antimicrobial therapy as prognostic variables. The primary outcome was 30-day mortality and secondary outcome was ICU admission. We also performed receiver operating characteristic curve analysis of Pneumonia Severity Index (PSI), Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) severe criteria, CURB-65 and A-DROP pneumonia severity scores.ResultsAmong 1834 CAP patients, mean age was 73.5 ± 14.3 years; 1281 (69.8%) were men; and 30-day mortality was 6.7% (122/1834). In total, 1830 patients were analyzed. Multivariate analysis identified age [Odds Ratio (OR): 1.04, 95% Confidence Interval (CI): 1.02–1.07], chronic obstructive pulmonary disease (COPD) [OR: 1.77, 95% CI: 1.13–2.76], malignancy (OR: 2.25, 95% CI: 1.25–4.06), body temperature (OR: 0.81, 95% CI: 0.67–0.99), respiratory rate (OR: 1.04, 95% CI: 1.01–1.07), PaO2/FiO2 ≤ 250 (OR: 3.15, 95% CI: 1.93–5.14), Alb (OR: 0.27, 95% CI: 0.19–0.39), BUN (OR: 1.01, 95% CI: 1.00–1.02), and mechanical ventilation (OR: 2.99, 95% CI: 1.75–5.12) as prognostic factors. AZM and β-lactam combination therapy significantly reduced 30-day mortality (OR: 0.50, 95% CI: 0.26–0.97). Areas under the curve of PSI, IDSA/ATS severe criteria, CURB-65 and A-DROP were 0.759, 0.746, 0.754 and 0.764, respectively.ConclusionsIncreasing age, presence of COPD and malignancy as comorbidities, hypothermia, tachypnea, PaO2/FiO2 ratio ≤250 mmHg, low Alb level, high BUN level and mechanical ventilatory support predict a worse prognosis; AZM combination therapy should be considered for CAP, excluding HCAP. All four pneumonia severity scores are useful for assessing the severity of CAP defined by the latest criteria.Trial registrationUMIN-CTR UMIN000004353. Registered 7 October 2010. Retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-017-0424-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort

et al. 2017

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“…In general, the serum albumin level is a representative marker of nutritional status; nutritional status deteriorates with swallowing disturbance and dementia in the elderly, resulting in a low albumin level. Moreover, albumin correlates with the mortality rate of patients with pneumonia [15][16][17][18]. In this study, serum albumin concentration was associated with survivals in patients with NHCAP in COX models.…”

Section: Discussionmentioning

confidence: 51%

“…On the recent reports, mortality in HCAP does not appear to be due to a higher frequency of multidrug resistant pathogens, such as methicillin resistant Staphylococcus aureus or Pseudomonas aeruginosa [3,15,22]. The risk factors for bacteria becoming multidrug resistant in HCAP include prior hospitalization, immunosuppression, previous antibiotic use, use of gastric acid-suppressive agents, and tube feeding [22].…”

Section: Discussionmentioning

confidence: 99%

Effects of Ampicillin/Sulbactam Dose and Dosing Frequency in Elderly Patients with Nursing- and Healthcare-Associated Pneumonia (Nhcap)

Yamazaki¹,

Sugawara²

2016

J Infect Dis Ther

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Japan has the most rapidly aging population in the world. This study aimed to examine the differences in the efficacy of ampicillin/sulbactam (ABPC/SBT) alone under different daily doses and daily dosing frequencies in elderly patients receiving healthcare at home and in elderly nursing home residents with pneumonia onset requiring hospitalization for treatment. By applying the Clinical Practice Guidelines for Nursing-and Healthcare-associated Pneumonia (NHCAP) of the Japanese Respiratory Society (JRS), we retrospectively analyzed clinical data, dose, dosing period, and the efficacy of antimicrobial agents, as well as outcomes of patients with NHCAP or community acquired pneumonia (CAP) who had been hospitalized at our department during the 3-year period of 2009 through 2011. The mean age of NHCAP patients (n=587) was 85 ± 9 years, significantly higher than the 77 ± 16 years of CAP patients (n=319). The serum albumin level in NHCAP patients was significantly lower than that in CAP patients. Among NHCAP patients, 82.5% received ABPC/SBT alone as the first-line therapy, with 50.7% receiving 1.5 g three times daily and 22.8% receiving 3 g twice daily. The mortality rate during hospitalization in the 1.5-g three-times-daily group was 12.4%, resulting in a significantly decrease as compared with the 3-g twice-daily group of 20.9% (p<0.01). In our study, which targeted the elderly in Japan, it was revealed that ABPC/SBT is an appropriate first choice of antibiotics in treating NHCAP and that administering 1.5 g three times daily is a suitable way of administration.

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“…Much has been written regarding what constitutes appropriate and/or optimal antibiotic treatment, and this has been extensively reviewed elsewhere (1,(7)(8)(9). However, while it is well recognised that inappropriate initial antibiotic therapy is associated with a worse outcome, it is also noted that even in the setting of appropriate initial antibiotic treatment, many patients still die (10). This has resulted in considerable interest in the potential role of adjunctive, anti-inflammatory therapies in the management of patients with CAP, particularly among the more seriously ill patients (1,(7)(8)(9)11,12).…”

Section: Review Articlementioning

confidence: 99%

“…This has resulted in considerable interest in the potential role of adjunctive, anti-inflammatory therapies in the management of patients with CAP, particularly among the more seriously ill patients (1,(7)(8)(9)11,12). Shindo and colleagues recently studied risk factors for 30-day mortality in patients with CAP who had received appropriate antibiotic therapy, with the aim of trying to identify patients who were most likely to benefit from adjunctive therapy (10).…”

Section: Review Articlementioning

confidence: 99%

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

Feldman¹

2016

J. Thorac. Dis.

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Improving the outcome of patients with community-acquired pneumonia (CAP) is an ongoing challenge, even in the setting of significant advances in antimicrobial chemotherapy and critical care.Recognition of the underlying involvement of inflammation-mediated organ dysfunction as a determinant of adverse outcomes in CAP has aroused intense interest in the protective potential of adjunctive antiinflammatory therapies in CAP, particularly the role of corticosteroids (CS). This is the primary topic of the current review which is focused on an evaluation of the latest meta-analyses encompassing both recent and earlier clinical trials, with particular emphasis on the stringent meta-analysis undertaken by Siemieniuk and colleagues (Ann Intern Med 2015;163:519-528). The review highlights the findings and recommendations of these and related published commentaries/critiques, while providing a brief description of those subgroups of patients who seemingly stand to benefit most from CS therapy. This is preceded by an overview of the mechanisms of the anti-inflammatory activities of CS, the interactions of these agents with macrolide antibiotics, and the potential benefits and risks of short-term administration of CS, concluding with a succinct appraisal of priority issues for ongoing and future research.

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Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study

Cited by 63 publications

References 33 publications

Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort

Prognostic factors in hospitalized community-acquired pneumonia: a retrospective study of a prospective observational cohort

Effects of Ampicillin/Sulbactam Dose and Dosing Frequency in Elderly Patients with Nursing- and Healthcare-Associated Pneumonia (Nhcap)

Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials

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