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 journalArticle

75 Citations (Scopus)

Abstract

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
Volume38
Issue number4
DOIs
StatePublished - Oct 1 2011

Fingerprint

Pneumonia
Guidelines
Delivery of Health Care
Therapeutics
Propensity Score
Mortality
Logistic Models
Veterans Health
United States Department of Veterans Affairs
Critical Illness
Cohort Studies
Anti-Bacterial Agents
Survival

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Attridge, R. T., Frei, C. R., Restrepo, M. I., Lawson, K. A., Ryan, L., Pugh, M. J. V., ... Mortensen, E. M. (2011). Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. European Respiratory Journal, 38(4), 878-887. https://doi.org/10.1183/09031936.00141110

Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. / Attridge, R. T.; Frei, C. R.; Restrepo, M. I.; Lawson, K. A.; Ryan, L.; Pugh, M. J V; Anzueto, A.; Mortensen, E. M.

In: European Respiratory Journal, Vol. 38, No. 4, 01.10.2011, p. 878-887.

Research output: Contribution to journalArticle

Attridge, RT, Frei, CR, Restrepo, MI, Lawson, KA, Ryan, L, Pugh, MJV, Anzueto, A & Mortensen, EM 2011, 'Guideline-concordant therapy and outcomes in healthcare-associated pneumonia', European Respiratory Journal, vol. 38, no. 4, pp. 878-887. https://doi.org/10.1183/09031936.00141110
Attridge RT, Frei CR, Restrepo MI, Lawson KA, Ryan L, Pugh MJV et al. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. European Respiratory Journal. 2011 Oct 1;38(4):878-887. https://doi.org/10.1183/09031936.00141110
Attridge, R. T. ; Frei, C. R. ; Restrepo, M. I. ; Lawson, K. A. ; Ryan, L. ; Pugh, M. J V ; Anzueto, A. ; Mortensen, E. M. / Guideline-concordant therapy and outcomes in healthcare-associated pneumonia. In: European Respiratory Journal. 2011 ; Vol. 38, No. 4. pp. 878-887.
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