Guideline-concordant therapy and outcomes in healthcare-associated pneumonia

R. T. Attridge, C. R. Frei, M. I. Restrepo, K. A. Lawson, L. Ryan, M. J.V. Pugh, A. Anzueto, E. M. Mortensen

Research output: Contribution to journalArticlepeer-review

94 Scopus citations


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 communityacquired 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.

Original languageEnglish (US)
Pages (from-to)878-887
Number of pages10
JournalEuropean Respiratory Journal
Issue number4
StatePublished - Oct 1 2011


  • Drug resistance
  • Guidelines for management of pneumonia
  • Health outcomes
  • Pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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