AJM Theme Issue: Pulmonology/Allergy
Clinical research study
Antibiotic Therapy and 48-Hour Mortality for Patients with Pneumonia

https://doi.org/10.1016/j.amjmed.2006.04.017Get rights and content

Abstract

Purpose

Although numerous articles have demonstrated that recommended empiric antimicrobial regimens are associated with decreased mortality at 30 days, there is controversy over whether appropriate antibiotic selection has a beneficial impact on mortality within the first 48 to 96 hours after admission. Our aim was to determine whether the use of guideline-concordant antibiotic therapy is associated with decreased mortality within the first 48 hours after admission for patients with pneumonia.

Methods

A retrospective cohort study was conducted at two tertiary teaching hospitals in San Antonio, Texas. A propensity score was used to balance the covariates associated with the use of guideline-concordant antimicrobial therapy. A multivariable logistic regression model was used to assess the association between mortality within 48 hours and the use of guideline-concordant antibiotic therapy, after adjusting for potential confounders including the propensity score.

Results

Information was obtained on 787 patients with community-acquired pneumonia. The median age was 60 years, 79% were male, and 20% were initially admitted to the intensive care unit. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. Within the first 48 hours, 20 patients died. After adjustment for potential confounders, the use of guideline-concordant antimicrobial therapy (odds ratio 0.37, 95% confidence interval, 0.14-0.95) was significantly associated with decreased mortality at 48 hours after admission.

Conclusion

Using initial empiric guideline-concordant antimicrobial therapy is associated with decreased mortality at 48 hours. Further research needs to investigate methods to ensure that patients with community-acquired pneumonia are treated with appropriate antimicrobial therapies.

Section snippets

Methods

This was a retrospective cohort study of patients hospitalized with community-acquired pneumonia at two academic tertiary care hospitals in San Antonio, Texas. Both hospitals are teaching affiliates of the University of Texas Health Science Center at San Antonio. The Institutional Review Board of the University of Texas Health Science Center at San Antonio approved the research protocol with exempt status.

Results

Data were abstracted on 787 patients at the 2 hospitals. The mean age was 60 years with a standard deviation of 16 years. Of the population, 79% were male, 84% were admitted through the emergency department, and 20% were admitted to the ICU within the first 24 hours after admission. Mortality was 2.5% at 48 hours, 9.2% at 30 days, and 13.6% at 90 days. By pneumonia severity index, 52% were low risk (pneumonia severity index classes I-III), 34% were moderate risk (pneumonia severity index class

Discussion

Community-acquired pneumonia continues to be an acute medical problem with substantial mortality and morbidity.2 Our study calls into question the concept that mortality within the first 48 to 96 hours after admission is not modifiable, and provides further evidence for the beneficial effect of the use of the empiric antimicrobial regimens recommended by the IDSA/ATS guidelines.

Our results strengthen the previous body of research addressing what antimicrobial therapies are appropriate for

Conclusion

This study demonstrates that receiving guideline-concordant antimicrobial therapy is associated with lower 48-hour mortality for patients hospitalized with community-acquired pneumonia. This finding provides further support for the use of empiric antimicrobial therapies consistent with guidelines from the IDSA and ATS.7, 19 Further research is needed to determine how to promote the use of guideline-concordant antimicrobial regimens for patients hospitalized with community-acquired pneumonia.

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    • Cited by (0)

    Dr. Mortensen was supported by a Department of Veteran Affairs Vertically Integrated Service Network 17 new faculty grant and a Howard Hughes Medical Institute faculty start-up grant 00378-001. Dr. Pugh was supported by Department of Veteran Affairs grants REA 05-129 and RCD 04-297. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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