Health care-associated pneumonia in the intensive care unit: Guideline-concordant antibiotics and outcomes.
Recent data have not demonstrated improved outcomes when guideline-concordant (GC) antibiotics are given to patients with health care-associated pneumonia (HCAP). This study was designed to evaluate the relationship between health outcomes and GC therapy in patients admitted to an intensive care unit (ICU) with HCAP.



We performed a population-based cohort study of patients admitted to greater than 150 hospitals in the US Veterans Health Administration system to compare baseline characteristics, bacterial pathogens, and health outcomes in ICU patients with HCAP receiving GC-HCAP therapy, GC community-acquired pneumonia (GC-CAP) therapy, or non-GC therapy. The primary outcome was 30-day patient mortality. Risk factors for the primary outcome were assessed in a multivariable logistic regression model.



A total of 3593 patients met inclusion criteria and received GC-HCAP therapy (26%), GC-CAP therapy (23%), or non-GC therapy (51%). Patients receiving GC-HCAP had higher 30-day patient mortality compared to GC-CAP patients (34% vs 22%; P< .0001). After controlling for confounders, risk factors for 30-day patient mortality were vasopressor use (odds ratio, 1.67; 95% confidence interval, 1.30-2.13), recent hospital admission (1.53; 1.15-2.02), and receipt of GC-HCAP therapy (1.51; 1.20-1.90).



Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.
Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX 78209; Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229. Electronic address: attridge@uiwtx.edu.
Russell T
RT
Attridge
College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: freic@uthscsa.edu.
Christopher R
CR
Frei
Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: pughm@uthscsa.edu.
Mary Jo V
MJ
Pugh
College of Pharmacy, The University of Texas at Austin, Austin, TX 78712. Electronic address: ken.lawson@austin.utexas.edu.
Kenneth A
KA
Lawson
College of Pharmacy, The University of Texas at Austin, Austin, TX 78712; Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: ryanl@uthscsa.edu.
Laurajo
L
Ryan
Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: anzueto@uthscsa.edu.
Antonio
A
Anzueto
University of Connecticut School of Medicine, Farmington, CT 06030. Electronic address: Metersky@nso.uchc.edu.
Mark L
ML
Metersky
Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX 78229; Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229. Electronic address: restrepom@uthscsa.edu.
Marcos I
MI
Restrepo
Section of General Internal Medicine, VA North Texas Health Care System, Dallas, TX 75216; Division of General Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390. Electronic address: eric.mortensen@utsouthwestern.edu.
Eric M
EM
Mortensen
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006787:Hospitals, Veterans; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents
Antibiotic therapy; Critical care; Guideline-concordant therapy; Health outcomes; Pneumonia