Timing of antibiotic administration and outcomes of hospitalized patients with community-acquired and healthcare-associated pneumonia

Abstract

The effects of antibiotic timing on outcomes of patients with community-acquired pneumonia (CAP) are controversial. Moreover, no information is available regarding this issue in healthcare-associated pneumonia (HCAP). We aimed to determine the impact of antibiotic timing on 30-day mortality of patients with CAP and HCAP. Non-immunocompromised adults admitted to hospital through the emergency department (ED) with community-onset pneumonia were prospectively observed from 2001 to 2009. Patients who received prior antibiotics were excluded. Of 1593 patients with pneumonia who were analyzed, 1274 had CAP and 319 HCAP. The mean time from patient arrival at the ED until antibiotic administration was 5.8 h (standard deviation (SD) 3.5) in CAP and 6.1 h (SD 3.8) in HCAP (p 0.30). Mortality was higher in patients with HCAP (5.5% vs. 13.5%; p <0.001). After adjusting for confounding factors in a logistic regression analysis, the antibiotic administration ≤4 h was not associated with decreased 30-day mortality in patients with CAP (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.57-2.21) and in patients with HCAP (OR 0.59, 95% CI 0.19-1.83). Similarly, antibiotic administration ≤8 h was not associated with decreased 30-day mortality in CAP (OR 1.58, 95% CI 0.64-3.88) and HCAP patients (OR 0.59, 95% CI 0.19-1.83). In conclusion, antibiotic administration within 4 or 8 h of arrival at the ED did not improve 30-day survival in hospitalized adults for CAP or HCAP.

Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients

“…Based on data showing that early appropriate administration of antimicrobials improves outcome in severe sepsis and septic shock, the same premise has been extrapolated to less-severe infections without proof of benefit. In patients with uncomplicated sepsis, the evidence for the timing of antimicrobial administration is contentious [10] and there are no studies substantiating the need for the same approach as is used in severe sepsis or septic shock. In fact, evidence to the contrary has been presented.…”

The Role of a Radiology Electronic Notification System in the Emergency Department Setting and Its Impact on Patient Care

“…One study found that CAP carries a mortality rate between 8% and 15% in hospitalized patients [7]. The data concerning the effectiveness of antibiotic timing are controversial in the current literature.…”

Community-acquired pneumonia: the elusive quest for the best treatment strategy

“…The biological plausibility of these latter associations and their causal relation are Commentary Community-acquired pneumonia: the elusive quest for the best treatment strategy unlikely. The three prospective studies failed to show a significant association between early antibiotic treatment and patient outcomes (5,6,11). These results might stem from a lack of power due to their smaller sample size or from more accurate adjustment for confounding factors.…”