Impact of Guideline-Concordant Empiric Antibiotic Therapy in Community-Acquired Pneumonia
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.
aUniversity of Texas at Austin College of Pharmacy, Austin, Tex
bUniversity of Texas Health Science Center at San Antonio, San Antonio, Tex
cVeterans Evidence-Based Research Dissemination and Implementation Center, San Antonio, Tex
dSouth Texas Veterans Health Care System, San Antonio, Tex.
Requests for reprints should be addressed to David S. Burgess, PharmD, Clinical Pharmacy Programs-MSC 6220, The University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900.
ABSTRACT
