title: Institution-specific patterns of infection and Gram's stain as guides for empiric treatment of patients hospitalized with typical community-acquired pneumonia.
abstract: OBJECTIVE
  To determine the appropriateness of cefazolin as empiric treatment of typical, as opposed to atypical, bacterial community-acquired pneumonia at our institution.
  
  
  METHODS
  Combination of retrospective chart review and prospective determination of microbial susceptibilities and cefazolin-associated cost savings.
  
  
  METHODS
  General acute-care referral hospital.
  
  
  METHODS
  We evaluated the charts of patients discharged with a diagnosis of community-acquired pneumonia over a 10-year period. Gram's stains and culture results of sputum samples processed over 2 months were analyzed to determine the ability of the stains to predict positive Haemophilus influenzae cultures. The susceptibility and beta-lactamase status of clinical isolates of H. influenzae were determined. Cost savings of cefazolin as empiric treatment for community-acquired pneumonia were evaluated.
  
  
  RESULTS
  The frequency of H. influenzae pneumonia at our institution was 15% of the three major bacterial community-acquired pneumonias. Gram's stain was highly accurate in predicting the presence or absence of Haemophilus sp in sputum. Five patients had positive outcomes with cefazolin treatment despite being diagnosed with H. influenzae pneumonia. The organism isolates demonstrated intermediate sensitivity to cefazolin and 85% were beta-lactamase negative. Our program that encourages empiric use of cefazolin over cefuroxime for typical bacterial community-acquired pneumonia has allowed a modest projected annual cost savings of $24,000.
  
  
  CONCLUSIONS
  We concluded that when Gram's stain of sputum does not show Haemophilus sp in patients with typical bacterial community-acquired pneumonia, empiric treatment with cefazolin is appropriate and results in cost savings.
authors.affiliation: Antibiotic Management Program, Hartford Hospital, Connecticut 06115.
authors.forename: P
authors.initials: P
authors.lastname: Belliveau
authors.forename: N
authors.initials: N
authors.lastname: Hickingbotham
authors.forename: E G
authors.initials: EG
authors.lastname: Maderazo
authors.forename: M
authors.initials: M
authors.lastname: Mazens-Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002437:Cefazolin / Q000191:economics / Q000627:therapeutic use*; D003237:Connecticut / Q000453:epidemiology; D017046:Cost Savings; D005260:Female; D005840:Gentian Violet; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology*; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010619:Phenazines; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology*; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology
chemical_list: C035863:Gram's stain; D010619:Phenazines; D002437:Cefazolin; D005840:Gentian Violet