期刊
EUROPEAN RESPIRATORY JOURNAL
卷 38, 期 4, 页码 878-887出版社
EUROPEAN RESPIRATORY SOC JOURNALS LTD
DOI: 10.1183/09031936.00141110
关键词
Drug resistance; guidelines for management of pneumonia; health outcomes; pneumonia
资金
- National Institute of Nursing Research (Bethesda, MD, USA) [R01NR010828]
- South Texas Veterans Health Care System (San Antonio, TX, USA)
- The University of Texas at Austin
- National Institutes of Health [KL2 RR025766, K23HL096054]
- The University of Texas at Austin College of Pharmacy
- Ortho-McNeil Janssen (Titusville, NJ, USA)
- South Texas Veterans Health Care System Audie L. Murphy Division
- The University of Texas Health Science Center at San Antonio
Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality in HCAP patients treated with either guideline-concordant (GC)-HCAP therapy or GC community-acquired pneumonia (CAP) therapy. We performed a population-based cohort study of >150 hospitals in the US Veterans Health Administration. Patients were included if they had one or more HCAP risk factors and received antibiotic therapy within 48 h of admission. Critically ill patients were excluded. Independent risk factors for 30-day mortality were determined in a generalised linear mixed-effect model, with admitting hospital as a random effect. Propensity scores for the probability of receiving GC-HCAP therapy were calculated and incorporated into a second logistic regression model. A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%) or non-GC therapy (16.3%). The strongest predictors of 30-day mortality were recent hospital admission (OR 2.49, 95% CI 2.12-2.94) and GC-HCAP therapy (OR 2.18, 95% CI 1.86-2.55). GC-HCAP therapy remained an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. In nonsevere HCAP patients, GC-HCAP therapy is not associated with improved survival compared with GC-CAP therapy.
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