Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia

Brandon J. Webb, Benjamin S. Dangerfield, Jabraan S. Pasha, Neera Agrwal, Holenarasipur R. Vikram

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The 2005 ATS/IDSA guidelines defined healthcare-associated pneumonia (HCAP) as a novel category of pneumonia in patients with significant healthcare exposure in whom the risk of drug resistant bacteria may be higher. In this study, we compare clinical outcomes in patients with HCAP who were treated with guideline-concordant antibiotic regimens with those who were not. Methods: Medical records of 100 patients meeting HCAP criteria admitted to an academic tertiary care hospital between January 2009 and January 2011 were retrospectively reviewed. Cases were divided into guideline-concordant and guideline-discordant groups based on antibiotic therapy. Demographic, microbiological and clinical outcome data were compared for both groups. Results: Patients in this cohort had multiple co-morbidities, severe pneumonia (mean PSI score 124.1), and significant mortality (22%). 21 of the 100 cases (21.0%) were culture positive, of which 11 (53.8%) represented drug-resistant pathogens. No statistically significant differences for any of the four clinical outcome measures were detected between the guideline-concordant therapy group and guideline-discordant group. In multivariate regression analysis controlling for possible confounders, similar results were observed, with the exception that length of stay was significantly longer (3.99 days, p < 0.001) in the discordant group. Three or more HCAP criteria (OR 10.89) and wound care (OR 6.32) were characteristics found to be associated with increased risk for drug-resistant pathogens. Conclusion: In our cohort, the HCAP model identified a population with significant co-morbidities and increased risk for drug-resistant pathogens, severe pneumonia, and increased mortality. However, clinical outcomes were not significantly improved with guideline-concordant antibiotic therapy.

Original languageEnglish (US)
Pages (from-to)1606-1612
Number of pages7
JournalRespiratory Medicine
Volume106
Issue number11
DOIs
StatePublished - Nov 2012

Fingerprint

Pneumonia
Guidelines
Anti-Bacterial Agents
Delivery of Health Care
Therapeutics
Pharmaceutical Preparations
Morbidity
Mortality
Tertiary Healthcare
Group Psychotherapy
Tertiary Care Centers
Medical Records
Length of Stay
Multivariate Analysis
Regression Analysis
Demography
Outcome Assessment (Health Care)
Bacteria
Wounds and Injuries
Population

Keywords

  • Antibiotic
  • Drug-resistant bacteria
  • Healthcare-associated
  • Pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Webb, B. J., Dangerfield, B. S., Pasha, J. S., Agrwal, N., & Vikram, H. R. (2012). Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia. Respiratory Medicine, 106(11), 1606-1612. https://doi.org/10.1016/j.rmed.2012.08.003

Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia. / Webb, Brandon J.; Dangerfield, Benjamin S.; Pasha, Jabraan S.; Agrwal, Neera; Vikram, Holenarasipur R.

In: Respiratory Medicine, Vol. 106, No. 11, 11.2012, p. 1606-1612.

Research output: Contribution to journalArticle

Webb, BJ, Dangerfield, BS, Pasha, JS, Agrwal, N & Vikram, HR 2012, 'Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia', Respiratory Medicine, vol. 106, no. 11, pp. 1606-1612. https://doi.org/10.1016/j.rmed.2012.08.003
Webb, Brandon J. ; Dangerfield, Benjamin S. ; Pasha, Jabraan S. ; Agrwal, Neera ; Vikram, Holenarasipur R. / Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia. In: Respiratory Medicine. 2012 ; Vol. 106, No. 11. pp. 1606-1612.
@article{c955dd6553f041e0a93c0d1040d3a339,
title = "Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia",
abstract = "Background: The 2005 ATS/IDSA guidelines defined healthcare-associated pneumonia (HCAP) as a novel category of pneumonia in patients with significant healthcare exposure in whom the risk of drug resistant bacteria may be higher. In this study, we compare clinical outcomes in patients with HCAP who were treated with guideline-concordant antibiotic regimens with those who were not. Methods: Medical records of 100 patients meeting HCAP criteria admitted to an academic tertiary care hospital between January 2009 and January 2011 were retrospectively reviewed. Cases were divided into guideline-concordant and guideline-discordant groups based on antibiotic therapy. Demographic, microbiological and clinical outcome data were compared for both groups. Results: Patients in this cohort had multiple co-morbidities, severe pneumonia (mean PSI score 124.1), and significant mortality (22{\%}). 21 of the 100 cases (21.0{\%}) were culture positive, of which 11 (53.8{\%}) represented drug-resistant pathogens. No statistically significant differences for any of the four clinical outcome measures were detected between the guideline-concordant therapy group and guideline-discordant group. In multivariate regression analysis controlling for possible confounders, similar results were observed, with the exception that length of stay was significantly longer (3.99 days, p < 0.001) in the discordant group. Three or more HCAP criteria (OR 10.89) and wound care (OR 6.32) were characteristics found to be associated with increased risk for drug-resistant pathogens. Conclusion: In our cohort, the HCAP model identified a population with significant co-morbidities and increased risk for drug-resistant pathogens, severe pneumonia, and increased mortality. However, clinical outcomes were not significantly improved with guideline-concordant antibiotic therapy.",
keywords = "Antibiotic, Drug-resistant bacteria, Healthcare-associated, Pneumonia",
author = "Webb, {Brandon J.} and Dangerfield, {Benjamin S.} and Pasha, {Jabraan S.} and Neera Agrwal and Vikram, {Holenarasipur R.}",
year = "2012",
month = "11",
doi = "10.1016/j.rmed.2012.08.003",
language = "English (US)",
volume = "106",
pages = "1606--1612",
journal = "Respiratory Medicine",
issn = "0954-6111",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - Guideline-concordant antibiotic therapy and clinical outcomes in healthcare-associated pneumonia

AU - Webb, Brandon J.

AU - Dangerfield, Benjamin S.

AU - Pasha, Jabraan S.

AU - Agrwal, Neera

AU - Vikram, Holenarasipur R.

PY - 2012/11

Y1 - 2012/11

N2 - Background: The 2005 ATS/IDSA guidelines defined healthcare-associated pneumonia (HCAP) as a novel category of pneumonia in patients with significant healthcare exposure in whom the risk of drug resistant bacteria may be higher. In this study, we compare clinical outcomes in patients with HCAP who were treated with guideline-concordant antibiotic regimens with those who were not. Methods: Medical records of 100 patients meeting HCAP criteria admitted to an academic tertiary care hospital between January 2009 and January 2011 were retrospectively reviewed. Cases were divided into guideline-concordant and guideline-discordant groups based on antibiotic therapy. Demographic, microbiological and clinical outcome data were compared for both groups. Results: Patients in this cohort had multiple co-morbidities, severe pneumonia (mean PSI score 124.1), and significant mortality (22%). 21 of the 100 cases (21.0%) were culture positive, of which 11 (53.8%) represented drug-resistant pathogens. No statistically significant differences for any of the four clinical outcome measures were detected between the guideline-concordant therapy group and guideline-discordant group. In multivariate regression analysis controlling for possible confounders, similar results were observed, with the exception that length of stay was significantly longer (3.99 days, p < 0.001) in the discordant group. Three or more HCAP criteria (OR 10.89) and wound care (OR 6.32) were characteristics found to be associated with increased risk for drug-resistant pathogens. Conclusion: In our cohort, the HCAP model identified a population with significant co-morbidities and increased risk for drug-resistant pathogens, severe pneumonia, and increased mortality. However, clinical outcomes were not significantly improved with guideline-concordant antibiotic therapy.

AB - Background: The 2005 ATS/IDSA guidelines defined healthcare-associated pneumonia (HCAP) as a novel category of pneumonia in patients with significant healthcare exposure in whom the risk of drug resistant bacteria may be higher. In this study, we compare clinical outcomes in patients with HCAP who were treated with guideline-concordant antibiotic regimens with those who were not. Methods: Medical records of 100 patients meeting HCAP criteria admitted to an academic tertiary care hospital between January 2009 and January 2011 were retrospectively reviewed. Cases were divided into guideline-concordant and guideline-discordant groups based on antibiotic therapy. Demographic, microbiological and clinical outcome data were compared for both groups. Results: Patients in this cohort had multiple co-morbidities, severe pneumonia (mean PSI score 124.1), and significant mortality (22%). 21 of the 100 cases (21.0%) were culture positive, of which 11 (53.8%) represented drug-resistant pathogens. No statistically significant differences for any of the four clinical outcome measures were detected between the guideline-concordant therapy group and guideline-discordant group. In multivariate regression analysis controlling for possible confounders, similar results were observed, with the exception that length of stay was significantly longer (3.99 days, p < 0.001) in the discordant group. Three or more HCAP criteria (OR 10.89) and wound care (OR 6.32) were characteristics found to be associated with increased risk for drug-resistant pathogens. Conclusion: In our cohort, the HCAP model identified a population with significant co-morbidities and increased risk for drug-resistant pathogens, severe pneumonia, and increased mortality. However, clinical outcomes were not significantly improved with guideline-concordant antibiotic therapy.

KW - Antibiotic

KW - Drug-resistant bacteria

KW - Healthcare-associated

KW - Pneumonia

UR - http://www.scopus.com/inward/record.url?scp=84866267949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866267949&partnerID=8YFLogxK

U2 - 10.1016/j.rmed.2012.08.003

DO - 10.1016/j.rmed.2012.08.003

M3 - Article

VL - 106

SP - 1606

EP - 1612

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

IS - 11

ER -