Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia
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Guidelines recommend administration of antibiotics with activity against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa for treatment of healthcare-associated pneumonia (HCAP). It is unclear if this therapy improves outcomes for patients with HCAP.
To determine if administration of guideline-similar therapy (GST) was associated with a reduction in 30-day mortality for HCAP.
Multi-center retrospective study.
Thirteen hundred and eleven admissions for HCAP in six Veterans Affairs Medical Centers.
Each admission was classified as receiving GST, anti-MRSA or anti-pseudomonal components of GST, or other non-HCAP therapy initiated within 48 hours of hospitalization. Association between 30-day mortality and GST was estimated with a logistic regression model that included GST, propensity to receive GST, probability of recovering an organism from culture resistant to antibiotics traditionally used to treat community-acquired pneumonia (CAP-resistance), and a GST by CAP-resistance probability interaction.
Odds ratios and 95% confidence intervals [OR (95% CI)] of 30-day mortality for patients treated with GST and predicted probability of recovering a CAP-resistant organism, and ratio of odds ratios [ROR (95% CI)] for treatment by CAP-resistance probability interaction.
Receipt of GST was associated with increased odds of 30-day mortality [OR = 2.11 (1.11, 4.04), P = 0.02)] as was the predicted probability of recovering a CAP-resistant organism [OR = 1.67 (1.26, 2.20), P < 0.001 for a 25% increase in probability]. An interaction between predicted probability of recovering a CAP-resistant organism and receipt of GST demonstrated lower mortality with GST at high probability of CAP resistance [ROR = 0.71(≤1.00) for a 25% increase in probability, P = 0.05].
For HCAP patients with high probability of CAP-resistant organisms, GST was associated with lower mortality. Consideration of the magnitude of patient-specific risk for CAP-resistant organisms should be considered when selecting HCAP therapy.
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- Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia
Journal of General Internal Medicine
Volume 27, Issue 7 , pp 845-852
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- anti-bacterial agents
- methicillin-resistant Staphylococcus aureus
- Pseudomonas aeruginosa
- healthcare-associated infection
- Industry Sectors
- Author Affiliations
- 1. Clinical Pharmacy Service (119A), Veterans Affairs Medical Center, 500 W Fort St, Boise, ID, USA, 83702
- 4. Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA
- 2. Research Service, Veterans Affairs Medical Center, Boise, ID, USA
- 5. Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA
- 7. Private Practice, Seattle, WA, USA
- 3. Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- 6. Department of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA