title: Effect of antibiotic guidelines on outcomes of hospitalized patients with nursing home-acquired pneumonia.
abstract: OBJECTIVE
  To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Three tertiary-care hospitals.
  
  
  METHODS
  Three hundred thirty-four nursing home patients.
  
  
  METHODS
  Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups.
  
  
  RESULTS
  Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (P=.006) and multilobar involvement (P=.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49-1.34, and OR=0.79, 95% CI=0.42-1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline.
  
  
  CONCLUSIONS
  In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline.
authors.affiliation: Veterans Affairs Western New York Healthcare System, Medical Research, Bldg. 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY 14215, USA. solh@buffalo.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: El Solh
authors.forename: Morohunfolu E
authors.initials: ME
authors.lastname: Akinnusi
authors.forename: Ziad
authors.initials: Z
authors.lastname: Alfarah
authors.forename: Anil
authors.initials: A
authors.lastname: Patel
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015897:Comorbidity; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009735:Nursing Homes; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents