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Respiratory Medicine

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Atypical coverage in community-acquired pneumonia after outpatient beta-lactam monotherapy - 26/07/17

Doi : 10.1016/j.rmed.2017.06.012 
Cornelis H. van Werkhoven a, ⁎ , Ewoudt M.W. van de Garde b, c, Jan Jelrik Oosterheert d, Douwe F. Postma d, Marc J.M. Bonten a, e
a Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands 
b Department of Clinical Pharmacy, St. Antonius Hospital Nieuwegein, The Netherlands 
c Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands 
d Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, The Netherlands 
e Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands 

∗Corresponding author. University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, PO-box 85500, 3508 GA Utrecht, The Netherlands.University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO-box 85500Utrecht3508 GAThe Netherlands

Abstract

Introduction

In adults hospitalized with community-acquired pneumonia (CAP) after >48 h of outpatient beta-lactam monotherapy, coverage of atypical pathogens is recommended based on expert opinion.

Methods

In a post-hoc analysis of a large study of CAP treatment we included patients who received beta-lactam monotherapy for >48 h before hospitalization. Length of hospital stay (LOS), 30-day mortality, and number of treatment escalations were compared for those that continued beta-lactam monotherapy and those that received atypical coverage at admission.

Results

Of 179 patients (median age 66 years (IQR 50–78), 100 (56%) male), 131 (73%) received additional atypical coverage at admission. These patients were younger, had less comorbidities, and longer symptom duration, compared to those that continued beta-lactam monotherapy. In crude analysis, median (IQR) LOS was 6 (4–8) and 6 (4–9) days, mortality was 2% and 4%, and treatment escalations occurred in 8 (17%) and 11 (8%) patients without and with atypical coverage, respectively. Adjusted effect ratios for absence of atypical coverage on LOS, mortality, and treatment escalation were 0.77 (95% CI 0.61–0.97), 0.37 (0.04–3.67), and 2.75 (0.94–8.09), respectively.

Conclusion

In adults hospitalized with CAP after >48 h of outpatient beta-lactam monotherapy, not starting antibiotics with atypical coverage was associated with a trend towards more treatment escalations, without evidence of increased LOS or mortality.

El texto completo de este artículo está disponible en PDF.

Highlights

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8% of CAP patients are admitted after >48 h outpatient beta-lactam monotherapy.
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Of these, in 27% atypical coverage was not added at admission.
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Patients without atypical coverage had 17% later treatment escalations versus 8%.
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No atypical coverage was not associated with increased length of stay or mortality.

El texto completo de este artículo está disponible en PDF.

Keywords : Community-acquired pneumonia, Antibiotics, Empirical treatment, Atypical pathogens, Treatment escalation


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© 2017  Elsevier Ltd. Reservados todos los derechos.
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Vol 129

P. 145-151 - août 2017 Regresar al número
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