Journal
JOURNAL OF CRITICAL CARE
Volume 36, Issue -, Pages 265-271Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2016.08.004
Keywords
Pneumonia; Critical care; Guideline-concordant therapy; Health outcomes; Antibiotic therapy
Categories
Funding
- National Institute of Nursing Research [R01NR010828]
- Agency for Health Care Research and Quality [1R24HS022418-01]
- National Heart, Lung, and Blood Institute [K23HL096054]
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Purpose: Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP. Materials and methods: We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model. Results: A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). Patients receiving GC-HCAP had higher 30-day patient mortality compared to GC-CAP patients (34% vs 22%; P<.0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (odds ratio, 1.67; 95% confidence interval, 1.30-2.13), recent hospital admission (1.53; 1.15-2.02), and receipt of GC-HCAP therapy (1.51; 1.20-1.90). Conclusions: Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy. Published by Elsevier Inc.
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