Impact of Guideline-Concordant Empiric Antibiotic Therapy in Community-Acquired Pneumonia

Christopher R. Frei, Marcos I. Restrepo, Eric M. Mortensen, David S. Burgess

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116 Scopus citations

Abstract

Purpose: We evaluated the impact of guideline-concordant empiric antibiotic therapy on time to clinical stability, time to switch therapy, length of hospital stay, and mortality among patients with community-acquired pneumonia. Methods: This is a retrospective cohort study of all adult community-acquired pneumonia patients managed at 5 community hospitals from November 1, 1999 to April 30, 2000. Patients were stratified into guideline-concordant and discordant groups as defined by the 2001 American Thoracic Society and the 2003 Infectious Diseases Society of America guidelines. Time to clinical stability, time to switch therapy, length of hospital stay, and in-hospital mortality were evaluated in per-protocol and intention-to-treat stepwise regression models that included the outcome as the dependent variable, guideline-concordant antibiotic therapy as the independent variable, and Pneumonia Severity Index score as a covariate. Results: Of the 631 evaluable patients, 357 (57%) received guideline-concordant empiric antibiotic therapy. Groups were similar with respect to age, sex, comorbidities, severity of illness, and processes of care. Guideline-concordant antibiotic therapy was associated with a significant decrease in time to switch therapy (P ≤.01), length of hospital stay (P ≤.01), and in-hospital mortality (P = .04) for both per-protocol and intention-to-treat analyses. In addition, guideline-concordant antibiotic therapy was associated with a significant decrease in time to clinical stability for intention-to-treat analysis only (P = .03). Conclusions: Among hospitalized community-acquired patients, guideline-concordant antibiotic therapy is associated with improved in-hospital survival and shorter time to clinical stability, time to switch therapy, and length of hospital stay.

Original languageEnglish
Pages (from-to)865-871
Number of pages7
JournalAmerican Journal of Medicine
Volume119
Issue number10
DOIs
StatePublished - Oct 2006

Bibliographical note

Funding Information:
The authors acknowledge the assistance of the following clinical pharmacists from Baptist Health-System, who assisted with data collection: Brian Barthol, PharmD, Renee Bellanger, PharmD, Donna Burgess, RPh, Paige Cuellar, PharmD, Julie Gilbert, PharmD, Jennifer Hammond, PharmD, Scott Hollis, RPh, Loretta Lemoine, RPh, Andi Lewis, PharmD, Jane Mondino, RPh, Jon Olson, PharmD, Nish Patel, PharmD, Liz Sanchez, RPh, Morris Sauter, PharmD, Thomas Shank, PharmD, Jacque Snow, PharmD, Paige Staudt, PharmD, and Mary Allyn Watson, PharmD. In addition, the authors would like to thank Michelle Tomasini and Michael Carden for their excellent technical assistance. This study was presented in part as a scientific poster presentation at the 43 rd Meeting of the Infectious Diseases Society of America, October 5-9, 2005, San Francisco, California. The study was partially supported by unrestricted research grants from Abbott Laboratories and Ortho McNeil Pharmaceuticals. The sponsors did not have any input into the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, and approval of the manuscript. In addition, Dr. Frei has received research grants from Abbott, Merck, Roche, and Wyeth. Dr. Restrepo has no financial relationships to disclose. Dr. Mortensen is supported by a Department of Veterans Affairs Vertically Integrated Service Network (VISN) 17 new faculty grant and Howard Hughes Medical Institute faculty start-up Grant 00378-001. Dr. Burgess has received research grants, served as a consultant, or served on a speaker’s bureau for the following pharmaceutical companies: Abbott, Merck, Ortho-McNeil, Roche, Sanofi-Aventis, and Wyeth. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Keywords

  • Antibiotics
  • Community-acquired pneumonia
  • Hospital length of stay
  • In-hospital mortality
  • Time-to-clinical stability
  • Time-to-switch therapy

ASJC Scopus subject areas

  • Medicine (all)

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