title: Guideline-concordant therapy and outcomes in healthcare-associated pneumonia.
abstract: Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality in HCAP patients treated with either guideline-concordant (GC)-HCAP therapy or GC community-acquired pneumonia (CAP) therapy. We performed a population-based cohort study of >150 hospitals in the US Veterans Health Administration. Patients were included if they had one or more HCAP risk factors and received antibiotic therapy within 48 h of admission. Critically ill patients were excluded. Independent risk factors for 30-day mortality were determined in a generalised linear mixed-effect model, with admitting hospital as a random effect. Propensity scores for the probability of receiving GC-HCAP therapy were calculated and incorporated into a second logistic regression model. A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%) or non-GC therapy (16.3%). The strongest predictors of 30-day mortality were recent hospital admission (OR 2.49, 95% CI 2.12-2.94) and GC-HCAP therapy (OR 2.18, 95% CI 1.86-2.55). GC-HCAP therapy remained an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. In nonsevere HCAP patients, GC-HCAP therapy is not associated with improved survival compared with GC-CAP therapy.
authors: Feik School of Pharmacy, University of the Incarnate Word, School of Medicine, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA.
authors: R T
authors: RT
authors: Attridge
authors: C R
authors: CR
authors: Frei
authors: M I
authors: MI
authors: Restrepo
authors: K A
authors: KA
authors: Lawson
authors: L
authors: L
authors: Ryan
authors: M J V
authors: MJ
authors: Pugh
authors: A
authors: A
authors: Anzueto
authors: E M
authors: EM
authors: Mortensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents