title: Prior outpatient antibacterial therapy as prognostic factor for mortality in hospitalized pneumonia patients.
abstract: OBJECTIVE
  To assess whether prior outpatient treatment is associated with outcome in patients hospitalized for community-acquired pneumonia (CAP).
  
  
  METHODS
  All patients with a first hospital admission for CAP between 1995 and 2000 were selected. Patients were divided into two groups, one of patients with use of antibacterial agents prior to hospitalization and one of patients treated as inpatient directly. The main outcome measures were duration of hospital stay and in-hospital mortality.
  
  
  RESULTS
  The two patient groups comprised 296 and 794 patients, respectively. The median duration of hospital stay was 10 days and was similar for both groups. In patients with respiratory diseases or heart failure, the median duration of hospital stay was 12 and 14 days, respectively. The overall in-hospital mortality was 7.2% and did not largely differ between both groups. In patients with congestive heart failure, the mortality was 9.8% for controls and 23.3% for patients hospitalized after initial outpatient treatment (adjusted OR 2.78, 95% CI 1.01-7.81).
  
  
  CONCLUSIONS
  Prior outpatient antibacterial therapy is not associated with outcome in hospitalized pneumonia patients. In patients with underlying chronic heart failure, prior outpatient antibiotic is associated with a significant increased mortality.
authors.affiliation: Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Sorbonnelaan 16, 3584 CA Utrecht, , and Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands. e.m.w.vandegarde@pharm.uu.nl
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.forename: Jules M M
authors.initials: JM
authors.lastname: van den Bosch
authors.forename: Vera H M
authors.initials: VH
authors.lastname: Deneer
authors.forename: Wim G
authors.initials: WG
authors.lastname: Goettsch
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Leufkens
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000150:complications / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011014:Pneumonia / Q000150:complications / Q000401:mortality*; D012140:Respiratory Tract Diseases / Q000150:complications; D018709:Statistics, Nonparametric; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents