title: Time to first antibiotics for pneumonia is not associated with in-hospital mortality.
abstract: BACKGROUND
  Time to first antibiotic (TTFA) is postulated to impact pneumonia mortality. The Joint Commission/Centers for Medicare and Medicaid Services national quality standards previously indicated that TTFA should be <6 h (modified from <4 h when the study was initiated, now eliminated as a time measure entirely).
  
  
  OBJECTIVE
  The purpose of this article was to determine whether TTFA is associated with inpatient mortality.
  
  
  METHODS
  The records of 444 consecutive patients admitted with pneumonia at a single institution were retrospectively reviewed for a correlation between TTFA and inpatient complications, including death. Statistical significance was set at p < 0.01 due to multiple comparisons.
  
  
  RESULTS
  Patients whose TTFA was <4 h had more complications (27% vs. 3%; p < 0.01) including death, intensive care unit admission, and intubation. These patients were judged sicker on arrival (median Emergency Severity Index 2 vs. 3; p < 0.001) and were more likely to be triaged to a critical care bed (36% vs. 5%; p < 0.001). Shortness of breath was the only presenting factor that was more frequent in the TTFA <4-h group (61% vs. 16%; p < 0.01).
  
  
  CONCLUSIONS
  Shorter TTFA is not associated with improved inpatient mortality. TTFA should not be considered to be a marker of quality of care but rather a reflection of patient disease severity.
authors.affiliation: Department of Emergency Medicine, Saint Anne's Hospital, Fall River, Massachusetts 02721, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Sucov
authors.forename: Jonathan
authors.initials: J
authors.lastname: Valente
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reinert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care / Q000706:statistics & numerical data; D004417:Dyspnea / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D056152:Respiratory Rate; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents