title: A clinical pathway for community-acquired pneumonia: an observational cohort study.
abstract: BACKGROUND
  Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.
  
  
  METHODS
  Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.
  
  
  RESULTS
  Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).
  
  
  CONCLUSIONS
  Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.
authors: College of Pharmacy, The University of Texas at Austin, 1 University Station A1900, Austin, TX 78712, USA. freic@uthscsa.edu
authors: Christopher R
authors: CR
authors: Frei
authors: Allison M
authors: AM
authors: Bell
authors: Kristi A
authors: KA
authors: Traugott
authors: Terry C
authors: TC
authors: Jaso
authors: Kelly R
authors: KR
authors: Daniels
authors: Eric M
authors: EM
authors: Mortensen
authors: Marcos I
authors: MI
authors: Restrepo
authors: Christine U
authors: CU
authors: Oramasionwu
authors: Andres D
authors: AD
authors: Ruiz
authors: William R
authors: WR
authors: Mylchreest
authors: Vanja
authors: V
authors: Sikirica
authors: Monika R
authors: MR
authors: Raut
authors: Alan
authors: A
authors: Fisher
authors: Jeff R
authors: JR
authors: Schein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D006801:Humans; D016018:Least-Squares Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents