title: Declining mortality among hospitalized patients with community-acquired pneumonia.
abstract: Little information is available on the changes over time in community-acquired pneumonia (CAP) management and their impact on 30-day mortality in hospitalized patients. We performed a prospective, observational study of non-severely immunosuppressed hospitalized adults with CAP from 1995 to 2014. A total of 4558 patients were included. Thirty-day mortality decreased from 9.6% in the first study period (1995-99) to 4.1% in the last period (2010-14); with a progressive downward trend (-0.2% death/year; p for trend = 0.003). Over time, patients were older (p 0.02), had more co-morbidities (p 0.037), more frequently presented severe illness according to the Pneumonia Severity Index (p <0.001) and septic shock (p <0.001), and more often required intensive care unit admission (p <0.001). Combination antibiotic therapy (p <0.001) and fluoroquinolone use (p <0.001) increased. Factors independently associated with 30-day mortality were increasing age (OR 1.04; 95% CI 1.03-1.05), co-morbidities (OR 1.48; 95% CI 1.04-2.11), shock at admission (OR 4.95; 95% CI 3.49-7.00), respiratory failure (OR 1.89; 95% CI 1.42-2.52), bacteraemia (OR 2.16; 95% CI 1.58-2.96), Gram-negative bacilli aetiology (OR 4.79; 95% CI 2.52-9.10) and fluoroquinolone use (OR 0.45; 95% CI 0.29-0.71). When we adjusted for a propensity score to receive fluoroquinolones, the protective effect of fluoroquinolone use was not confirmed. In conclusion, 30-day mortality decreased significantly over time in hospitalized patients with CAP in spite of an upward trend in patient age and other factors associated with poor outcomes. Several changes in the management of CAP and a general improvement in global care over time may have caused the observed outcomes.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: A F
authors.initials: AF
authors.lastname: Simonetti
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain. Electronic address: carolgv75@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Garcia-Vidal
authors.affiliation: Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Barranquilla, Colombia.
authors.forename: D
authors.initials: D
authors.lastname: Viasus
authors.affiliation: Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: García-Somoza
authors.affiliation: Department of Respiratory Diseases, Hospital Universitari de Bellvitge Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Dorca
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
authors.affiliation: Department of Infectious Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI), Madrid, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Antibiotics; community-acquired pneumonia; management; prognosis; time-trends