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- Title
Guideline-Based Antibiotics and Mortality in Healthcare-Associated Pneumonia.
- Authors
Madaras-Kelly, Karl; Remington, Richard; Sloan, Kevin; Fan, Vincent
- 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.
- Subjects
PNEUMONIA-related mortality; METHICILLIN-resistant staphylococcus aureus; ANTIBIOTICS; ANTIBACTERIAL agents; RETROSPECTIVE studies; NOSOCOMIAL infections
- Publication
JGIM: Journal of General Internal Medicine, 2012, Vol 27, Issue 7, p845
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-012-2011-y