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Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia

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ABSTRACT

Background

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.

Objective

To determine if administration of guideline-similar therapy (GST) was associated with a reduction in 30-day mortality for HCAP.

Design

Multi-center retrospective study.

Participants

Thirteen hundred and eleven admissions for HCAP in six Veterans Affairs Medical Centers.

Interventions

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.

Main Measures

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.

Key Results

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].

Conclusions

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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Acknowledgements

This study was supported through a grant from the National Institute of Allergy and Infectious Diseases (RO3AI074894-01A2). This work was supported in part with resources of the Boise and Puget Sound Health Care System Veterans Affairs Medical Centers.

This work was presented in part at the 51st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, Il.; September 19th, 2011, Abstract # 1453.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Clinical Pharmacy Service (119A), Veterans Affairs Medical Center, 500 W Fort St, Boise, ID, USA, 83702

    Karl J. Madaras-Kelly PharmD, MPH

  2. Research Service, Veterans Affairs Medical Center, Boise, ID, USA

    Richard E. Remington MS

  3. Medical Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA

    Vincent S. Fan MD, MPH

  4. Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA

    Karl J. Madaras-Kelly PharmD, MPH

  5. Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA

    Richard E. Remington MS

  6. Department of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Vincent S. Fan MD, MPH

  7. Private Practice, Seattle, WA, USA

    Kevin L. Sloan MD

Authors
  1. Karl J. Madaras-Kelly PharmD, MPH
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  2. Richard E. Remington MS
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  3. Kevin L. Sloan MD
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  4. Vincent S. Fan MD, MPH
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Corresponding author

Correspondence to Karl J. Madaras-Kelly PharmD, MPH.

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Madaras-Kelly, K.J., Remington, R.E., Sloan, K.L. et al. Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia. J GEN INTERN MED 27, 845–852 (2012). https://doi.org/10.1007/s11606-012-2011-y

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  • DOI: https://doi.org/10.1007/s11606-012-2011-y

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