title: Guideline-concordant antimicrobial therapy for healthcare-associated pneumonia: a systematic review and meta-analysis.
abstract: BACKGROUND
  The objective of this study was to perform a systematic review and meta-analysis of the impact of the 2005 American Thoracic Society/Infectious Diseases Society of America guideline-concordant antimicrobial therapy (GCAT) on mortality following healthcare-associated pneumonia (HCAP).
  
  
  METHODS
  We searched MEDLINE, EMBASE, BIOSIS, Cochrane CENTRAL Register of Controlled Trials, and Scopus for clinical trials and observational studies comparing GCAT to other treatment regimens in adults with HCAP. The primary outcome chosen was 30-day mortality from any cause. Secondary outcomes assessed length of hospital stay and time to clinical stability. Random effects models were used to generate pooled odds ratios (ORs) and weighed mean differences (WMDs). Heterogeneity was evaluated by the I(2).
  
  
  RESULTS
  A total of six studies were included in the analysis and involved 15,850 participants. Meta-analysis showed that GCAT was associated with increased 30-day mortality compared to non-GCAT (OR 1.80, 95 % confidence interval [CI] 1.26-2.7). There was no advantage in GCAT over non-GCAT in terms of hospital length of stay (WMD 1.18 days, 95 % CI -0.48 to 2.84) or time to clinical stability (WMD 0.17 days, 95 % CI -0.32 to 0.67).
  
  
  CONCLUSIONS
  In hospitalized patients with HCAP, GCAT did not show survival benefit compared to non-GCAT. However, our results are limited by the cohort design of the selected studies and the degree of heterogeneity among them. Future trials are needed to identify risk factors for multidrug-resistant pathogens in HCAP patients who may benefit from broad-spectrum antimicrobial regimens.
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Western New York Respiratory Research Center, University at Buffalo School of Medicine and Biomedical Sciences, 3495 Bailey Avenue, Buffalo, NY 14215-1199, USA.
authors.forename: Anthony X
authors.initials: AX
authors.lastname: Troitino
authors.forename: Jahan
authors.initials: J
authors.lastname: Porhomayon
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents