Medline ® Abstracts for References 2,76
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
Epidemiology and predictors of multidrug-resistant community-acquired and health care-associated pneumonia.
Gross AE, Van Schooneveld TC, Olsen KM, Rupp ME, Bui TH, Forsung E, Kalil AC
Antimicrob Agents Chemother. 2014 Sep;58(9):5262-8. Epub 2014 Jun 23.
There are limited U.S. data describing the risk factors for multidrug-resistant organism (MDRO) isolation in community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP). However, concern for the presence of these pathogens drives the prescribing of empiric broad-spectrum antibiotics for CAP and HCAP. A retrospective study of all adults hospitalized with community-onset pneumonia (CAP and HCAP) at a large U.S. medical center from January 2010 to December 2011 was conducted. The objective was to ascertain the rate of pneumonia caused by MDROs and to evaluate whether HCAP is a risk factor for MDRO pneumonia. Univariate and propensity score-adjusted multivariate analyses were performed. A total of 521 patients (50.5% CAP and 49.5% HCAP) were included. The most common etiologies of pneumonia were primary viral and Streptococcus pneumoniae. MDROs were isolated in 20 (3.8%) patients overall, and MDROs occurred in 5.9% and 1.9% of HCAP and CAP patients, respectively. The presence of an MDRO was not associated with HCAP classification (odds ratio [OR]=1.95; 95% confidence interval [95% CI], 0.66 to 5.80; P=0.23) or with most of its individual components (hemodialysis, home infusion, home wound care, and≥48-h hospitalization in the last 90 days). Independent predictors of MDRO included the following: Pseudomonas aeruginosa colonization/infection in the previous year (OR=7.43; 95% CI, 2.24 to 24.61; P<0.001), antimicrobial use in the previous 90 days (OR=2.90; 95% CI, 1.13 to 7.45; P=0.027), admission from a nursing home (OR=4.19; 95% CI, 1.55 to 11.31; P=0.005), and duration of hospitalization in the previous 90 or 180 days (P=0.013 and P=0.002, respectively). MDROs were uncommon in HCAP and CAP. HCAP did not predict MDRO isolation. Local etiology of community onset pneumonia and specific MDRO risk factors should be integrated into therapeutic decisions to prevent empirical overprescribing of antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) and P. aeruginosa.
University of Illinois at Chicago, College of Pharmacy, Chicago, Illinois, USA University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska, USA University of Nebraska Medical Center, College of Medicine, Omaha, Nebraska, USA firstname.lastname@example.org.
Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis.
Daniel P, Rodrigo C, Mckeever TM, Woodhead M, Welham S, Lim WS, British Thoracic Society
Thorax. 2016 Jun;71(6):568-70. Epub 2015 Nov 11.
A matched-propensity analysis of national data from the British Thoracic Society community-acquired pneumonia audit was conducted (n=13 725). Overall, time to first antibiotic (TFA) was≤4 h in 63%. Adjusted 30-day inpatient (IP) mortality was lower for adults with TFA≤4 h compared with TFA>4 h (adjusted OR 0.84, 95% CI 0.74 to 0.94; p=0.003). Increasing TFA was associated with greater OR of 30-day IP mortality (p value for trend=0.001), but no TFA threshold was evident. Although we found an association between TFA and mortality, we cannot say whether this is causal or whether TFA might just be a quality measure for overall or other processes of care.
Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK.