AJM Theme Issue: Pulmonology/Allergy
Clinical research study
Impact of Guideline-Concordant Empiric Antibiotic Therapy in Community-Acquired Pneumonia

https://doi.org/10.1016/j.amjmed.2006.02.014Get rights and content

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.

Section snippets

Methods

This is a retrospective cohort study of all adult patients hospitalized with community-acquired pneumonia at 5 community hospitals within the Baptist Health-System from November 1, 1999 to April 30, 2000. Institutional Review Board approval was obtained from the Baptist Health-System and The University of Texas Health Science Center at San Antonio before beginning the study.

Results

A total of 631 community-acquired pneumonia patients were managed on the medical ward, and 57% of patients received guideline-concordant antibiotic therapy. The guideline-concordant group comprised patients treated with a β-lactam plus a macrolide (71%) or fluoroquinolone monotherapy (29%). Patients in the guideline discordant group received primarily β-lactam monotherapy (31%) or a β-lactam plus a fluoroquinolone (25%). No other regimen was administered to more than 5% of patients in the

Discussion

Our study is one of several to identify an association between guideline-concordant antibiotic therapy and patient mortality or length of hospital stay.10, 11, 12, 13 However, to our knowledge, this is the first study to demonstrate that guideline-concordant antibiotic therapy is associated with a reduced time to clinical stability and time to switch therapy. This association is paramount because it helps identify a clinical intervention (eg, appropriate empiric antibiotic therapy) that could

Conclusion

Guideline-concordant antibiotic therapy is associated with shorter time to clinical stability, time to switch therapy, decreased length of hospital stay, and improved survival among hospitalized community-acquired pneumonia patients.

Acknowledgment

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,

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