Guideline-concordant antibiotic therapy is not associated with improved outcomes in healthcare-associated pneumonia

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Title: Guideline-concordant antibiotic therapy is not associated with improved outcomes in healthcare-associated pneumonia
Author: Attridge, Russell Thomas
Abstract: Background : 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 and length of stay (LOS ) in HCAP patients treated with either guideline -concordant HCAP (GC -HCAP ) therapy or guideline -concordant community -acquired pneumonia (GC -CAP ) therapy . Methods : We performed a retrospective cohort study of >150 hospitals in the Veterans Health Administration . Patients were included if they had ≥1 HCAP risk factor and received antibiotic therapy within 48 hours of admission . Patients were excluded if they received ICU care , had cardiovascular or respiratory organ failure , or received invasive mechanical ventilation and /or vasopressors . We determined independent risk factors for 30 -day mortality with a multivariable logistic regression model including baseline characteristics , individual HCAP risk factors , comorbidities , and organ failure as dichotomous covariates . Propensity scores were calculated for the probability to receive GC -HCAP therapy and incorporated into a second logistic regression model . Results : A total of 15 ,071 patients met study criteria and received GC -HCAP therapy (8 .0 % ) , GC -CAP therapy (75 .7 % ) , or non -guideline -concordant therapy (16 .3 % ) . GC -HCAP patients were more likely to have neoplastic disease ; whereas , GC -CAP patients had a higher prevalence of other comorbidities , tobacco use , and recent medication use . In multivariable regression , recent hospital admission (OR 2 .47 , 95 % CI 2 .10 -2 .91 ) and GC -HCAP therapy (2 .13 , 1 .82 -2 .48 ) were the strongest predictors of 30 -day mortality . Hematologic organ failure , non -invasive mechanical ventilation , neoplastic disease , renal organ failure , and cerebrovascular disease were also independent risk factors . Use of cardiovascular medications , inhaled corticosteroids , and tobacco were protective . GC -HCAP therapy continued to be an independent risk factor for 30 -day mortality (OR 2 .12 , 95 % CI 1 .82 -2 .48 ) in the propensity score analysis . Conclusions : GC -HCAP therapy is not associated with improved survival in HCAP patients .
URI: http : / /hdl .handle .net /2152 /ETD -UT -2010 -05 -1126
Date: 2010-10-26

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Guideline-concordant antibiotic therapy is not associated with improved outcomes in healthcare-associated pneumonia. Master's thesis, University of Texas at Austin. Available electronically from http : / /hdl .handle .net /2152 /ETD -UT -2010 -05 -1126 .

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