Guideline-concordant antibiotic use and survival among patients with community-acquired pneumonia admitted to the intensive care unit

Christopher R. Frei, Russell T. Attridge, Eric M. Mortensen, Marcos I. Restrepo, Yifan Yu, Christine U. Oramasionwu, Jessica L. Ruiz, David S. Burgess

Research output: Contribution to journalArticlepeer-review

83 Scopus citations


Objective: This study evaluated the survival benefit of US community-acquired pneumonia (CAP) practice guidelines in the intensive care unit (ICU) setting. Methods: We conducted a retrospective cohort study of adult patients with CAP who were admitted to 5 community hospital ICUs between November 1, 1999, and April 30, 2000. The guidelines for antibiotic prescriptions were the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines. Guideline-concordant antimicrobial therapy was defined as a β-lactam plus fluoroquinolone or macrolide, antipseudomonal β-lactam plus fluoroquinolone, or antipseudomonal β-lactam plus aminoglycoside plus fluoroquinolone or macrolide. Patients with a documented β-lactam allergy were considered to have received guideline-concordant therapy if they received a fluoroquinolone with or without clindamycin, or aztreonam plus fluoroquinolone with or without aminoglycoside. All other antibiotic regimens were considered to be guideline discordant. Time to clinical stability, time to oral antibiotics, length of hospital stay, and in-hospital mortality were evaluated with regression models that included the outcome as the dependent variable, guidelineconcordant antibiotic therapy as the independent variable, and the Pneumonia Severity Index (PSI) score and facility as covariates. Results: The median age of the 129 patients included in the study was 71 years (interquartile range, 60-79 years). Sixty-two of 129 patients (48%) were male. Comorbidities included liver dysfunction (7 patients [5%]), heart failure (62 [48%]), renal dysfunction (39 [30%]), cerebrovascular disease (21 [16%]), and cancer (14 [11%]). The median (25th-75th percentile) PSI score was 119 (98-142), and overall mortality was 19% (25 patients). Patient demographics were similar between groups. Fifty-three patients (41%) received guideline-endorsed therapies. Guideline-discordant therapy was associated with an increase in inpatient mortality (25% vs 11%; odds ratio = 2.99 [95% CI, 1.08-9.54]). Receipt of guideline-concordant antibiotics was not associated with reductions in time to clinical stability, time to oral antibiotics, or length of hospital stay when patients who died were excluded from the analysis. Conclusion: Guideline-concordant empiric antibiotic therapy was associated with improved survival among these patients with CAP who were admitted to 5 ICUs.

Original languageEnglish
Pages (from-to)293-299
Number of pages7
JournalClinical Therapeutics
Issue number2
StatePublished - Feb 2010

Bibliographical note

Funding Information:
Dr. Frei has received research grants from Ortho-McNeil Janssen, Elan, AstraZeneca, Abbott, Merck, Roche, and Wyeth, and has served as a consultant and advisory-board member for Ortho-McNeil Janssen. Dr. Restrepo has served on speakers’ bureaus for Ortho-McNeil Janssen, Johnson & Johnson, and Pfizer, and on advisory boards for Ortho-McNeil Janssen and Johnson & Johnson. Dr. Mortensen’s work was supported by grants from the Department of Veterans Affairs Vertically Integrated Service Network and Howard Hughes Medical Institute. Dr. Burgess has received honoraria, received research grants, served as a consultant, or served on speakers’ bureaus for the following pharmaceutical companies: Abbott, Astra-Zeneca, Merck, Ortho-McNeil Janssen, Roche, sanofi-aventis, and Wyeth. The authors have indicated that they have no other conflicts of interest regarding the content of this article.


  • antibiotics
  • bacterial pneumonia
  • community-acquired pneumonia
  • guidelines
  • health outcomes
  • mortality

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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