期刊论文详细信息
BMC Infectious Diseases
Clinical implications for patients treated inappropriately for community-acquired pneumonia in the emergency department
Marin H Kollef3  Nicholas B Hampton1  Brian M Fuller4  Adam Lang5  Scott T Micek2 
[1] BJC Learning Institute, 8300 Eager Road, Mail Stop 92-92-241, St. Louis, MO 63144, USA;St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110-1088, USA;Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8052, St. Louis, MO 63110, USA;Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St. Louis, MO 63110, USA;Creighton University, 2500 California Plaza, Omaha, NE 68178, USA
关键词: Outcomes;    Resistant pathogens;    Antibiotics;    Pneumonia;   
Others  :  1134757
DOI  :  10.1186/1471-2334-14-61
 received in 2013-10-31, accepted in 2014-02-04,  发布年份 2014
PDF
【 摘 要 】

Background

Community-acquired pneumonia (CAP) is one of the most common infections presenting to the emergency department (ED). Increasingly, antibiotic resistant bacteria have been identified as causative pathogens in patients treated for CAP, especially in patients with healthcare exposure risk factors.

Methods

We retrospectively identified adult subjects treated for CAP in the ED requiring hospital admission (January 2003-December 2011). Inappropriate antibiotic treatment, defined as an antibiotic regimen that lacked in vitro activity against the isolated pathogen, served as the primary end point. Information regarding demographics, severity of illness, comorbidities, and antibiotic treatment was recorded. Logistic regression was used to determine factors independently associated with inappropriate treatment.

Results

The initial cohort included 259 patients, 72 (27.8%) receiving inappropriate antibiotic treatment. There was no difference in hospital mortality between patients receiving inappropriate and appropriate treatment (8.3% vs. 7.0%; p = 0.702). Hospital length of stay (10.3 ± 12.0 days vs. 7.0 ± 8.9 days; p = 0.017) and 30-day readmission (23.6% vs. 12.3%; p = 0.024) were greater among patients receiving inappropriate treatment. Three variables were independently associated with inappropriate treatment: admission from long-term care (AOR, 9.05; 95% CI, 3.93-20.84), antibiotic exposure in the previous 30 days (AOR, 1.85; 95% CI, 1.35-2.52), and chronic obstructive pulmonary disease (AOR, 2.05; 95% CI, 1.52-2.78).

Conclusion

Inappropriate antibiotic treatment of presumed CAP in the ED negatively impacts patient outcome and readmission rate. Knowledge of risk factors associated with inappropriate antibiotic treatment of presumed CAP could advance the management of patients with pneumonia presenting to the ED and potentially improve patient outcomes.

【 授权许可】

   
2014 Micek et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150306062929362.pdf 248KB PDF download
Figure 1. 25KB Image download
【 图 表 】

Figure 1.

【 参考文献 】
  • [1]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: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007, 44:S27-S72.
  • [2]Welte T, Torres A, Nathwani D: Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012, 67:71-79.
  • [3]File TM Jr, Marrie TJ: Burden of community-acquired pneumonia in North American adults. Postgrad Med 2010, 122:130-141.
  • [4]Huang SS, Johnson KM, Ray GT, Wroe P, Lieu TA, Moore MR, Zell ER, Linder JA, Grijalva CG, Metlay JP, Finkelstein JA: Healthcare utilization and cost of pneumococcal disease in the United States. Vaccine 2011, 29:3398-3412.
  • [5]Ewig S, Torres A: Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality. Eur Respir J 2011, 38:253-260.
  • [6]Feldman C, Anderson R: Antibiotic resistance of pathogens causing community-acquired pneumonia. Semin Respir Crit Med 2012, 33:232-243.
  • [7]Fujitani S, Yu VL: A new category–healthcare-associated pneumonia: a good idea, but problems with its execution. Eur J Clin Microbiol Infect Dis 2006, 25:627-631.
  • [8]American Thoracic Society; Infectious Diseases Society of America: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005, 71:388-416.
  • [9]Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS: Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005, 128:3854-3862.
  • [10]Venditti M, Falcone M, Corrao S, Licata G, Serra P, Study Group of the Italian Society of Internal Medicine: Outcomes of patients hospitalized with community-acquired, healthcare- associated, and hospital-acquired pneumonia. Ann Intern Med 2009, 150:19-26.
  • [11]Hsu JL, Siroka AM, Smith MW, Holodniy M, Meduri GU: One-year outcomes of community-acquired and healthcare-associated pneumonia in the Veterans Affairs Healthcare System. Int J Infect Dis 2011, 15:e382-e387.
  • [12]Jung JY, Park MS, Kim YS, Park BH, Kim SK, Chang J, Kang YA: Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital. BMC Infect Dis 2011, 11:61. BioMed Central Full Text
  • [13]Falcone M, Venditti M, Shindo Y, Kollef MH: Healthcare-associated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis 2011, 15:e545-e550.
  • [14]Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH: Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007, 51:3568-3573.
  • [15]Kollef MH, Morrow LE, Baughman RP, Craven DE, McGowan JE Jr, Micek ST, Niederman MS, Ost D, Paterson DL, Segreti J: Health care-associated pneumonia (HCAP): a critical appraisal to improve identification, management, and outcomes–proceedings of the HCAP Summit. Clin Infect Dis 2008, 46:S296-S334.
  • [16]Micek ST, Reichley RM, Kollef MH: Health care-associated pneumonia (HCAP): empiric antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa predict optimal outcome. Medicine (Baltimore) 2011, 90:390-395.
  • [17]Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT: Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003, 58:377-382.
  • [18]Shorr AF, Zilberberg MD, Micek ST, Kollef MH: Prediction of infection due to antibiotic resistant bacteria by select risk factors for health care-associated pneumonia. Arch Intern Med 2008, 168:2205-2210.
  • [19]Schreiber MP, Chan CM, Shorr AF: Resistant pathogens in nonnosocomial pneumonia and respiratory failure: is it time to refine the definition of health-care-associated pneumonia? Chest 2010, 137:1283-1288.
  • [20]Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, Imaizumi K, Sato T, Hasegawa Y: Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest 2009, 135:633-640.
  • [21]Oster G, Berger A, Edelsberg J, Weber DJ: Initial treatment failure in non-ICU community-acquired pneumonia: risk factors and association with length of stay, total hospital charges, and mortality. J Med Econ 2013, 16:809-819.
  • [22]Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, Micek ST, Kollef MH: Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals. Clin Infect Dis 2013, 57:362-367.
  • [23]Jenkins TC, Sakai J, Knepper BC, Swartwood CJ, Haukoos JS, Long JA, Price CS, Burman WJ: Risk factors for drug-resistant Streptococcus pneumoniae and antibiotic prescribing practices in outpatient community-acquired pneumonia. Acad Emerg Med 2012, 19:703-706.
  • [24]Kollef MH: Ventilator-associated pneumonia. A multivariate analysis. JAMA 1993, 270:1965-1970.
  • [25]Seymann GB, Di Francesco L, Sharpe B, Rohde J, Fedullo P, Schneir A, Fee C, Chan KM, Fatehi P, Dam TT: The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia. Clin Infect Dis 2009, 49:1868-1874.
  • [26]Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, Micek ST, Kollef MH: Validation of a clinical score for assessing the risk of resistant pathogens in patients with pneumonia presenting to the emergency department. Clin Infect Dis 2012, 54:193-198.
  • [27]Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, Tarsia P, Mantero M, Blasi F: Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 2012, 54:470-478.
  • [28]Park SC, Kang YA, Park BH, Kim EY, Park MS, Kim YS, Kim SK, Chang J, Jung JY: Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia. Respir Med 2012, 106:1311-1319.
  • [29]Garcia-Vidal C, Viasus D, Roset A, Adamuz J, Verdaguer R, Dorca J, Gudiol F, Carratalà J: Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization. Clin Microbiol Infect 2011, 17:1659-1665.
  • [30]Chalmers JD, Taylor JK, Singanayagam A, Fleming GB, Akram AR, Mandal P, Choudhury G, Hill AT: Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis 2011, 53:107-113.
  • [31]Kett DH, Cano E, Quartin AA, Mangino JE, Zervos MJ, Peyrani P, Cely CM, Ford KD, Scerpella EG, Ramirez JA, Improving Medicine through Pathway Assessment of Critical Therapy of Hospital-Acquired Pneumonia (IMPACT-HAP) Investigators: Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis 2011, 11:181-189.
  • [32]Attridge RT, Frei CR, Restrepo MI, Lawson KA, Ryan L, Pugh MJ, Anzueto A, Mortensen EM: Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. Eur Respir J 2011, 38:878-887.
  • [33]Ewig S, Welte T, Torres A: Is healthcare-associated pneumonia a distinct entity needing specific therapy? Curr Opin Infect Dis 2012, 25:166-175.
  • [34]Labelle AJ, Arnold H, Reichley RM, Micek ST, Kollef MH: A comparison of culture-positive and culture-negative health-care-associated pneumonia. Chest 2010, 137:1130-1137.
  • [35]Taylor SP, Taylor BT: Healthcare-associated pneumonia in hemodialysis patients: Clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy. Respirology 2013, 18:364-367.
  • [36]Falcone M, Corrao S, Licata G, Serra P, Venditti M: Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study. Intern Emerg Med 2012, 7:523-531.
  • [37]Lawrence KL, Kollef MH: Antimicrobial stewardship in the intensive care unit: advances and obstacles. Am J Respir Crit Care Med 2009, 179:434-438.
  • [38]Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Shiraki A, Goto Y, Fukui Y, Iwaki M, Okumura J, Yamaguchi I, Yagi T, Tanikawa Y, Sugino Y, Shindoh J, Ogasawara T, Nomura F, Saka H, Yamamoto M, Taniguchi H, Suzuki R, Saito H, Kawamura T, Hasegawa Y: Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013, 188:985-995.
  文献评价指标  
  下载次数:2次 浏览次数:4次