Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes

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• 作者：Russell T. Attridge ; PharmD ; MSc^a ; ^b ; ^{attridge@uiwtx.edu" class="auth_mail" title="E-mail the corresponding author} ; Christopher R. Frei ; PharmD ; MSc^c ; ^d ; ^{freic@uthscsa.edu" class="auth_mail" title="E-mail the corresponding author} ; Mary Jo V. Pugh ; PhD^b ; ^e ; ^{pughm@uthscsa.edu" class="auth_mail" title="E-mail the corresponding author} ; Kenneth A. Lawson ; PhD^c ; ^{ken.lawson@austin.utexas.edu" class="auth_mail" title="E-mail the corresponding author} ; Laurajo Ryan ; PharmD ; MSc^c ; ^d ; ^e ; ^{ryanl@uthscsa.edu" class="auth_mail" title="E-mail the corresponding author} ; Antonio Anzueto ; MD^b ; ^e ; ^{anzueto@uthscsa.edu" class="auth_mail" title="E-mail the corresponding author} ; Mark L. Metersky ; MD^f ; ^{Metersky@nso.uchc.edu" class="auth_mail" title="E-mail the corresponding author} ; Marcos I. Restrepo ; MD ; MSc^b ; ^e ; ^{restrepom@uthscsa.edu" class="auth_mail" title="E-mail the corresponding author} ; Eric M. Mortensen ; MD ; MSc^g ; ^h ; ^{eric.mortensen@utsouthwestern.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Pneumonia ; Critical care ; Guideline-concordant therapy ; Health outcomes ; Antibiotic therapy
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：265-271
• 全文大小：330 K

文摘

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.