Early administration of antibiotics does not shorten time to clinical stability in patients with moderate-to-severe community-acquired pneumonia.
OBJECTIVE
To determine if there is a statistically significant difference in the time to clinical stability (TCS) between those patients with moderate-to-severe (MTS) community-acquired pneumonia (CAP) who received their antibiotics within 4 h and those who received their antibiotics after 4 h.


METHODS
Prospective observational study.


METHODS
A large metropolitan teaching institution with 62,000 annual emergency department visits from May 1999 through January 2001.


METHODS
Patients were > or = 21 year with MTS CAP as defined by the Pneumonia Patient Outcomes Research Team (PORT).


METHODS
Triage-to-needle time (group 1, 0 to 240 min; group 2, 241 to 480 min; and group 3, > 480 min) was the independent variable, and TCS was the dependent variable. Our hypothesis was that door-to-needle time < 4 h would result in TCS reduction of 0.5 days.


METHODS
Statistical analysis was performed using the two-tailed Student t test, analysis of variance, and multiple linear regression; p < 0.05 was considered significant.


RESULTS
Four hundred nine patients with MTS CAP achieved clinical stability during their hospital stay. Fifty-four percent of patients received antibiotics within 4 h. The mean time to receiving antibiotics was 131.46 min (2.19 h) in group 1, 335.52 min (5.59 h) in group 2, and 783.98 min (13.07 h) in group 3. Mean TCS was 3.19 days in group 1, 3.16 days in group 2, and 3.29 days in group 3. There were no statistically significant differences in TCS between the study groups.


CONCLUSIONS
The administration of antibiotics within 4 h does not reduce the TCS in adult patients with MTS-CAP, as defined by the PORT group. Future studies using other physiologic parameters should be explored.
Silber
Steven H
SH
Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA. sts9005@nyp.org
Garrett
Christopher
C
Singh
Rakesh
R
Sweeney
Angela
A
Rosenberg
Carl
C
Parachiv
Diana
D
Okafo
Tobi
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents