title: Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.
abstract: BACKGROUND
  An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome.
  
  
  METHODS
  A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded.
  
  
  RESULTS
  Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class.
  
  
  CONCLUSIONS
  Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.
authors.affiliation: Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain. rmenend@separ.es
authors.forename: R
authors.initials: R
authors.lastname: Menéndez
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: R
authors.initials: R
authors.lastname: Zalacaín
authors.forename: J
authors.initials: J
authors.lastname: Aspa
authors.forename: J J
authors.initials: JJ
authors.lastname: Martín Villasclaras
authors.forename: L
authors.initials: L
authors.lastname: Borderías
authors.forename: J M
authors.initials: JM
authors.lastname: Benítez Moya
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-Manzano
authors.forename: F
authors.initials: F
authors.lastname: Rodríguez de Castro
authors.forename: J
authors.initials: J
authors.lastname: Blanquer
authors.forename: D
authors.initials: D
authors.lastname: Pérez
authors.forename: C
authors.initials: C
authors.lastname: Puzo
authors.forename: F
authors.initials: F
authors.lastname: Sánchez Gascón
authors.forename: J
authors.initials: J
authors.lastname: Gallardo
authors.forename: C
authors.initials: C
authors.lastname: Alvarez
authors.forename: L
authors.initials: L
authors.lastname: Molinos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents