title: Improvement in clinical and economic outcomes with empiric antibiotic therapy covering atypical pathogens for community-acquired pneumonia patients: a multicenter cohort study.
abstract: OBJECTIVE
  To determine the effectiveness of empiric antibiotic regimens covering atypical pathogens with respect to detailed clinical and economic outcomes in community-acquired pneumonia (CAP).
  
  
  METHODS
  A population-based, multicenter, retrospective cohort study was conducted from June 2010 to May 2011. Patients with a diagnosis of CAP were enrolled and categorized into two groups according to the initial antibiotic strategy used - covering or not covering atypical pathogens. Regression analysis was performed to assess their clinical outcomes (all-cause mortality, clinical improvement rate after 72 h of antimicrobial therapy, and clinical cure rate) and economic outcomes (length of stay, hospitalization costs, and antibiotic expenditure).
  
  
  RESULTS
  A total of 827 patients met the criteria for CAP; 561 (67.8%) received antibiotics with atypical pathogen coverage (APC group), while 266 (32.2%) did not (non-APC group). Regression analysis revealed that the all-cause mortality was much lower in the APC group than in the non-APC group (0.9% vs. 4.9%, respectively), with an odds ratio (OR) of 0.18 (95% confidence interval (CI) 0.06-0.49). Clinical improvement at 72 h (87.7% vs. 85.0%, p=0.274) and the clinical cure rate (91.1% vs. 88.3%, p=0.213) were more favorable in the APC group, but with no significant difference compared to the non-APC group. Moreover, the APC group had a shorter mean length of stay (APC 10.2 days vs. non-APC 11.6 days, p<0.001). In addition, the mean total hospitalization costs for the APC group were markedly lower compared with the non-APC group (US$ 1172.7 vs. US$ 1510.7; p<0.001).
  
  
  CONCLUSIONS
  Antimicrobial treatment covering atypical pathogens for hospitalized CAP patients is associated with reduced mortality and economic burden.
authors: Department of Respiratory Medicine, Fudan University affiliated Zhongshan Hospital, 180 Fenglin Rd, Xuhui District, Shanghai 200032, China.
authors: Xiangru
authors: X
authors: Ye
authors: Department of Respiratory Medicine, Ningbo University affiliated Yingzhou Hospital, Zhejiang, China.
authors: Jian
authors: J
authors: Ma
authors: Department of Respiratory Medicine, Fudan University affiliated Zhongshan Hospital, 180 Fenglin Rd, Xuhui District, Shanghai 200032, China. Electronic address: hubijie@vip.sina.com.
authors: Bijie
authors: B
authors: Hu
authors: Department of Hospital Infection Control and Management, Fudan University affiliated Zhongshan Hospital, Shanghai, China.
authors: Xiaodong
authors: X
authors: Gao
authors: Department of Respiratory Medicine, Fudan University affiliated Zhongshan Hospital, 180 Fenglin Rd, Xuhui District, Shanghai 200032, China.
authors: Lixian
authors: L
authors: He
authors: Department of Respiratory Medicine, Cixi No. 3 People's Hospital, Zhejiang, China.
authors: Wei
authors: W
authors: Shen
authors: Department of Respiratory Medicine, Ningbo No. 7 Hospital, Zhejiang, China.
authors: Lei
authors: L
authors: Weng
authors: Department of Respiratory Medicine, Wuxi No. 4 People's Hospital, Jiangsu, China.
authors: Liming
authors: L
authors: Cai
authors: Department of Respiratory Medicine, Wuxi XiShang Hospital, Jiangsu, China.
authors: Yonggang
authors: Y
authors: Huang
authors: Department of Respiratory Medicine, Cixi No. 1 People's Hospital, Zhejiang, China.
authors: Zheng
authors: Z
authors: Hu
authors: Department of Respiratory Medicine, Hangzhou Red Cross Hospital, Zhejiang, China.
authors: Jianpu
authors: J
authors: Xu
authors: Department of Respiratory Medicine, Hangzhou Red Cross Hospital, Zhejiang, China.
authors: Lan
authors: L
authors: Zhao
authors: Department of Respiratory Medicine, Hangzhou No. 3 Hospital, Zhejiang, China.
authors: Meijiang
authors: M
authors: Huang
authors: Department of Respiratory Medicine, Jiangshu Shengzhe Hospital, Jiangsu, China.
authors: Xuefan
authors: X
authors: Cui
authors: Department of Respiratory Medicine, Central Hospital of Shanghai Jiading District, Shanghai, China.
authors: Chunling
authors: C
authors: Tu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic therapy; Atypical pathogen; CAP