Medline ® Abstracts for References 2,77,78
of 'Treatment of community-acquired pneumonia in adults who require hospitalization'
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America, American Thoracic Society
Clin Infect Dis. 2007;44 Suppl 2:S27.
McMaster University Medical School, Hamilton, Ontario, Canada. 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.
Early administration of antibiotics does not shorten time to clinical stability in patients with moderate-to-severe community-acquired pneumonia.
Silber SH, Garrett C, Singh R, Sweeney A, Rosenberg C, Parachiv D, Okafo T
STUDY OBJECTIVE: To determine if there is a statistically significant difference in the time to clinical stability (TCS) between those patients with moderate-to-severe (MTS) community-acquired pneumonia (CAP) who received their antibiotics within 4 h and those who received their antibiotics after 4 h.
DESIGN: Prospective observational study.
SETTING: A large metropolitan teaching institution with 62,000 annual emergency department visits from May 1999 through January 2001.
PATIENTS: Patients were>or = 21 year with MTS CAP as defined by the Pneumonia Patient Outcomes Research Team (PORT).
INTERVENTIONS: Triage-to-needle time (group 1, 0 to 240 min; group 2, 241 to 480 min; and group 3,>480 min) was the independent variable, and TCS was the dependent variable. Our hypothesis was that door-to-needle time<4 h would result in TCS reduction of 0.5 days.
MEASUREMENTS: Statistical analysis was performed using the two-tailed Student t test, analysis of variance, and multiple linear regression; p<0.05 was considered significant.
RESULTS: Four hundred nine patients with MTS CAP achieved clinical stability during their hospital stay. Fifty-four percent of patients received antibiotics within 4 h. The mean time to receiving antibiotics was 131.46 min (2.19 h) in group 1, 335.52 min (5.59 h) in group 2, and 783.98 min (13.07 h) in group 3. Mean TCS was 3.19 days in group 1, 3.16 days in group 2, and 3.29 days in group 3. There were no statistically significant differences in TCS between the study groups.
CONCLUSION: The administration of antibiotics within 4 h does not reduce the TCS in adult patients with MTS-CAP, as defined by the PORT group. Future studies using other physiologic parameters should be explored.
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA. email@example.com