The American Journal of Medicine
Volume 119, Issue 10 , Pages 859-864 , October 2006

Antibiotic Therapy and 48-Hour Mortality for Patients with Pneumonia

  • Eric M. Mortensen, MD, MSc

      Affiliations

    • Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Tex
    • Division of General Internal Medicine, South Texas Veterans Health Care System, San Antonio, Tex
    • Corresponding Author InformationRequests for reprints should be addressed to Eric Mortensen, MD, MSc, VERDICT, ALMD/UTHSCSA, Ambulatory Care (11C6), 7400 Merton Minter Boulevard, San Antonio, TX 78284.
  • ,
  • Marcos I. Restrepo, MD, MSc

      Affiliations

    • Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Tex
    • Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, Tex.
  • ,
  • Antonio Anzueto, MD

      Affiliations

    • Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, Tex.
  • ,
  • Jacqueline A. Pugh, MD

      Affiliations

    • Veterans Evidence Based Research Dissemination and Implementation Center, South Texas Veterans Health Care System, San Antonio, Tex
    • Division of General Internal Medicine, South Texas Veterans Health Care System, San Antonio, Tex

Received 27 September 2005 ,Accepted 5 April 2006.

References 

  1. Austrian R, Gold J. Pneumococcal bacteremia with special reference to bacteremic pneumococcal pneumonia. Ann Intern Med. 1964;60:759–776
  2. Freid VM, Prager K, MacKay AP, Xia H. Health, United States, 2003 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics; 2003;
  3. Gilbert K, Fine MJ. Assessing prognosis and predicting patient outcomes in community-acquired pneumonia. Semin Respir Infect. 1994;9(3):140–152
  4. Society BT. Guidelines for the management of community-acquired pneumonia in adults admitted to the hospital. Br J Hosp Med. 1993;49(5):346–350
  5. Gialdroni Grassi G, Bianchi L. Guidelines for the management of community-acquired pneumonia in adults (Italian Society of Pneumology. Italian Society of Respiratory Medicine. Italian Society of Chemotherapy). Monaldi Arch Chest Dis. 1995;50(1):21–27
  6. Niederman M, Bass JB, Campbell GD, et al. Guidelines for the initial management of adult with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. Am Rev Respir Dis. 1993;148:1418–1426
  7. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia (Diagnosis, assessment of severity, antimicrobial therapy, and prevention). Am J Respir Crit Care Med. 2001;163(7):1730–1754
  8. Bartlett JG, Dowell SF, Mandell LA, File TM, Musher DM, Fine MJ. Practice guidelines for the management of community-acquired pneumonia in adults (Infectious Diseases Society of America). Clin Infect Dis. 2000;31(2):347–382
  9. British Thoracic Society guidelines for the management of community acquired pneumonia in adults. Thorax. 2001;56(Suppl 4):IV1–IV64
  10. Mandell LA, Marrie TJ, Grossman RF, et al. Summary of Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Can Respir J. 2000;7(5):371–382
  11. Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ. Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia. Arch Intern Med. 1999;159(21):2562–2572
  12. Houck PM, MacLehose RF, Niederman MS, Lowery JK. Empiric antibiotic therapy and mortality among Medicare pneumonia inpatients in 10 Western States: 1993, 1995, and 1997. Chest. 2001;119:1420–1426
  13. Battleman DS, Callahan M, Thaler HT. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia. Arch Intern Med. 2002;162:682–688
  14. Waterer GW, Somes GW, Wunderink RG. Monotherapy may be suboptimal for severe bacteremic pneumococcal pneumonia. Arch Intern Med. 2001;161(15):1837–1842
  15. Mortensen EM, Restrepo M, Anzueto A, Pugh J. Effects of guideline-concordant antimicrobial therapy on mortality among patients with community-acquired pneumonia. Am J Med. 2004;117(10):726–731
  16. Wunderink RG, Waterer GW. Community-acquired pneumonia: pathophysiology and host factors with focus on possible new approaches to management of lower respiratory tract infections. Infect Dis Clin North Am. 2004;18(4):743–759vii
  17. Marrie T. Community-acquired Pneumonia. New York, NY: Kluwer Academic; 2001;
  18. Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA. 1997;278(23):2080–2084
  19. Mandell LA, Bartlett JG, Dowell SF, File TM, Musher DM, Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2003;37(11):1405–1433
  20. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–250
  21. Stone RA, Obrosky DS, Singer DE, Kapoor WN, Fine MJ Pneumonia Patient Outcomes Research Team (PORT) Investigators. Propensity score adjustment for pretreatment differences between hospitalized and ambulatory patients with community-acquired pneumonia. Med Care. 1995;33(4 Suppl):AS56–AS66
  22. Klungel OH, Martens EP, Psaty BM, et al. Methods to assess intended effects of drug treatment in observational studies are reviewed. J Clin Epidemiol. 2004;57(12):1223–1231
  23. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55
  24. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: John Wiley and sons; 1989;(Wiley series in probability and mathematical statistics).
  25. Brown RB, Iannini P, Gross P, Kunkel M. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest. 2003;123:1503–1511
  26. Malone DC, Shaban HM. Adherence to ATS guidelines for hospitalized patients with community-acquired pneumonia. Ann Pharmacother. 2001;35:1180–1185
  27. Shefet D, Robenshtok E, Leibovici L. Empirical atypical coverage for inpatients with community-acquired pneumonia. Arch Intern Med. 2005;165:1992–2000

 Dr. Mortensen was supported by a Department of Veteran Affairs Vertically Integrated Service Network 17 new faculty grant and a Howard Hughes Medical Institute faculty start-up grant 00378-001. Dr. Pugh was supported by Department of Veteran Affairs grants REA 05-129 and RCD 04-297. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

PII: S0002-9343(06)00446-3

doi: 10.1016/j.amjmed.2006.04.017

The American Journal of Medicine
Volume 119, Issue 10 , Pages 859-864 , October 2006