title: Early administration of the first antimicrobials should be considered a marker of optimal care of patients with community-acquired pneumonia rather than a predictor of outcomes.
abstract: BACKGROUND
  The effect of time of the first antimicrobial dose (TFAD) on the outcomes of community-acquired pneumonia (CAP) remains a controversy.
  
  
  METHODS
  This was an observational, retrospective study of consecutive adult patients hospitalized with CAP. TFAD was defined as the time in hours from arrival at the emergency department to the intravenous infusion of antimicrobial. All patients received appropriate antibiotic therapy according to available Infectious Diseases Society of America/American Thoracic Society guidelines during the time of our study. Multivariable analysis and a propensity score adjusted methodology were used to measure the association of TFAD with mortality, time to clinical stability (TCS), and length of stay in the hospital (LOS).
  
  
  RESULTS
  Data of 372 patients with CAP were studied. A total 29 (8.4%) patients died within 30 days of hospitalization. Our propensity-adjusted logistic regression model did not show a significant association between TFAD and mortality (p=0.148). Patients who died received antimicrobials significantly earlier than survivors: 5.7h vs. 7.5h, respectively (p=0.04). The LOS and TCS were not significantly affected by the TFAD; the LOS hazard ratio was 0.996 (95% confidence interval 0.97-1.02; p=0.774) and the TCS hazard ratio was 1.01 (95% confidence interval 0.98-1.03; p=0.604).
  
  
  CONCLUSIONS
  TFAD does not seem to be associated with the clinical outcome of patients with CAP. Early TFAD should be considered as an important marker of optimal care of patients with CAP rather than as a factor predicting outcomes.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Providence Hospital, Washington, DC, USA. jbordon@provhosp.org
authors.forename: Jose
authors.initials: J
authors.lastname: Bordon
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.forename: Padmaraj
authors.initials: P
authors.lastname: Duvvuri
authors.forename: Timothy
authors.initials: T
authors.lastname: Wiemken
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: Inez
authors.initials: I
authors.lastname: Natividad
authors.forename: Alfredo
authors.initials: A
authors.lastname: Caceres-Lara
authors.forename: Robert
authors.initials: R
authors.lastname: Delapenha
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D003422:Critical Care; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D059039:Standard of Care; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents