title: Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.
abstract: BACKGROUND
  Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital.
  
  
  METHODS
  We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS).
  
  
  RESULTS
  Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics.
  
  
  CONCLUSIONS
  Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.
authors.affiliation: Centers for Medicare & Medicaid Services, Seattle, WA 98121, USA. phouck@cms.hhs.gov
authors.forename: Peter M
authors.initials: PM
authors.lastname: Houck
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.forename: Allen
authors.initials: A
authors.lastname: Ma
authors.forename: John G
authors.initials: JG
authors.lastname: Bartlett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017721:Hospital Costs; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics / Q000592:standards*; D015999:Multivariate Analysis; D011014:Pneumonia / Q000188:drug therapy* / Q000191:economics; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents