Health care–associated pneumonia in the intensive care unit

Guideline-concordant antibiotics and outcomes

Russell T. Attridge, Chris Frei, Mary Jo V Pugh, Kenneth A. Lawson, Laurajo Ryan, Antonio R Anzueto, Mark L. Metersky, Marcos Restrepo, Eric M. Mortensen

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)265-271
Number of pages7
JournalJournal of Critical Care
Volume36
DOIs
StatePublished - Dec 1 2016

Fingerprint

Intensive Care Units
Pneumonia
Guidelines
Anti-Bacterial Agents
Health
Therapeutics
Mortality
Logistic Models
Veterans Health
United States Department of Veterans Affairs
Cohort Studies
Odds Ratio
Confidence Intervals

Keywords

  • Antibiotic therapy
  • Critical care
  • Guideline-concordant therapy
  • Health outcomes
  • Pneumonia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Health care–associated pneumonia in the intensive care unit : Guideline-concordant antibiotics and outcomes. / Attridge, Russell T.; Frei, Chris; Pugh, Mary Jo V; Lawson, Kenneth A.; Ryan, Laurajo; Anzueto, Antonio R; Metersky, Mark L.; Restrepo, Marcos; Mortensen, Eric M.

In: Journal of Critical Care, Vol. 36, 01.12.2016, p. 265-271.

Research output: Contribution to journalArticle

Attridge, Russell T. ; Frei, Chris ; Pugh, Mary Jo V ; Lawson, Kenneth A. ; Ryan, Laurajo ; Anzueto, Antonio R ; Metersky, Mark L. ; Restrepo, Marcos ; Mortensen, Eric M. / Health care–associated pneumonia in the intensive care unit : Guideline-concordant antibiotics and outcomes. In: Journal of Critical Care. 2016 ; Vol. 36. pp. 265-271.
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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.",
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N2 - 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.

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