Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-Acquired Pneumonia

Abstract

Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.

Evidence‐based sepsis therapy: A hospitalist perspective

“…Receiving antibiotics within 4 hours reduced in-hospital and 30-day mortality by 15% and length of stay by 0.4 days. 18 Similar conclusions were reported by 3 of 4 previous analyses. 19 -22 Extending these findings to critically ill patients, Iregui et al found that delayed treatment with appropriate antibiotics (odds ratio, 7.68) was a greater predictor of mortality for 107 patients with ventilator-acquired pneumonia than were APACHE II scores and malignancy; 31% failed to receive appropriate antibiotics within 24 hours, and again, three quarters of these delays resulted from delays in writing antibiotic orders.…”

“…They found that 39.1% of the patients waited more than 4 hours for antibiotics and 7.6% waited more than 12 hours; three quarters of these delays resulted from delayed ordering of antibiotics. 18 Further, 21.2% received an antibiotic selection incompatible with recent professional guidelines. Receiving antibiotics within 4 hours reduced in-hospital and 30-day mortality by 15% and length of stay by 0.4 days.…”

“…However, hospitalists may also see patients who qualify for these therapies when they are called to see septic patients in the emergency department, when severe sepsis develops in patients on the medicine ward, or when they provide consultation services in an ICU. Sepsis care must be implemented urgently; patients in the pivotal trial of steroids had to be randomized within 3 hours of shock onset, 47 data suggest that the window for optimal antibiotic therapy may be no greater than 4 hours from diagnosis, 18 whereas guidelines suggest therapy within 1 hour, 11 and early goal-directed therapy was studied only for the first 6 or more hours of hospitalization. 36 Thus, hospitalists who do not provide ICU care should be able to identify patients with severe sepsis and either deliver initial care or recognize the need for immediate consultation.…”

“…74 Figure 3 compares the corresponding NNT values to save 1 life; according to the available data, a hospitalist is 5-8 times more likely to save a life with EGDT than with fibrinolysis. Because the literature supporting several major sepsis therapies have been limited to retrospective studies [18][19][20][21][22][23][24][25][26][27][28] and single randomized, controlled trials 29,36 and because key trials are still underway (CORTICUS, NICE-SUGAR), the benefits of sepsis therapies are less certain than are those for the treatment of MI. This was underscored by the finding that the benefit in reduced mortality of intensive insulin in the surgical ICU 57 did not extend to all patients in the medical ICU.…”

Defining Antibiotic Dosing in Lung Infections

“…1 Inadequate empirical antibiotic therapy is associated with reduced survival in patients with severe lung infection 2 and, thus early and appropriate antibiotic therapy is an essential intervention. 3 Optimizing antibiotic exposure for lung infections is challenging, especially when considering drug penetration into the lung tissue. Although infection can occur throughout most of the lung, alveolar compartments such as epithelial lining fluid (ELF) or the cells (alveolar macrophage, AM) are considered as the area where pathogens commonly accumulate during lung infections and thus antibiotic penetration into such compartments is of high importance.…”