Russell T Attridge1, Christopher R Frei2, Mary Jo V Pugh3, Kenneth A Lawson4, Laurajo Ryan5, Antonio Anzueto6, Mark L Metersky7, Marcos I Restrepo8, Eric M Mortensen9. 1. Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209; Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229. Electronic address: attridge@uiwtx.edu. 2. College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: freic@uthscsa.edu. 3. Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: pughm@uthscsa.edu. 4. College of Pharmacy, The University of Texas at Austin, Austin, TX 78712. Electronic address: ken.lawson@austin.utexas.edu. 5. College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: ryanl@uthscsa.edu. 6. Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: anzueto@uthscsa.edu. 7. University of Connecticut School of Medicine, Farmington, CT 06030. Electronic address: Metersky@nso.uchc.edu. 8. Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: restrepom@uthscsa.edu. 9. Section of General Internal Medicine, VA North Texas Health Care System, Dallas, TX 75216; Division of General Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390. Electronic address: eric.mortensen@utsouthwestern.edu.
Abstract
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.
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-CAPpatients (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.
Entities:
Keywords:
Antibiotic therapy; Critical care; Guideline-concordant therapy; Health outcomes; Pneumonia
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