title: The Roles of the Charlson Comorbidity Index and Time to First Antibiotic Dose as Predictors of Outcome in Pneumococcal Community-Acquired Pneumonia.
abstract: In this retrospective study, we aimed to investigate the role of comorbidities using the Charlson comorbidity index (CCI) and time to first antibiotic dose (TFAD) in patients with pneumococcal community-acquired pneumonia (PCAP).
  
  
  
  All consecutive ER admissions with PCAP who were hospitalized in the University Hospital, Zurich between 2006 and 2012 were included. The primary outcome was to determine possible determinants of all-cause in-hospital mortality (ACIHM). The second endpoint was to detect risk factors for adverse events (AEs) and determinants of length of stay (LOS).
  
  
  
  108 subjects (mean age 57.6 years) were included. The median (IQR) CCI was 4 (1, 8). The median (IQR) TFAD was 210 (150, 280) min. ACIHM was 6.5 % (7/108), and median (IQR) LOS was 9 (6, 14) days. PCAP-related AEs were observed in 57 cases (52.8 %). In the multivariable analysis, neither CCI nor TFAD was associated with the outcome measures. Pneumonia severity index (PSI) was the only statistically significant predictor of ACIHM (HR 1.31/10 point increase, 95 % CI 1.12-1.53, p = 0.001) and AE rate (OR 1.31, 95 % CI 1.15-1.50, p < 0.001).
  
  
  
  In this study including comparatively young patients with rather mild disease severity, we found no strong evidence supporting that CCI or TFAD influenced short-term outcome measures of PCAP. Yet, pneumonia severity appears to be the most important factor for the outcome.
authors.affiliation: Department of Pulmonology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. daniel.franzen@usz.ch.
authors.forename: Daniel
authors.identifier: 0000-0001-6080-9555
authors.initials: D
authors.lastname: Franzen
authors.affiliation: Department of Pulmonology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Marisa
authors.initials: M
authors.lastname: Lim
authors.affiliation: Department of Pulmonology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bratton
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Kuster
authors.affiliation: Department of Pulmonology, University Hospital and University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D061665:Time-to-Treatment
chemical_list: D000900:Anti-Bacterial Agents
keywords: Comorbidity; Pneumococcal community-acquired pneumonia; Pneumonia severity index; Short-term outcome; Time to first antibiotic dose