title: Antibiotic therapy prior to hospital admission is associated with reduced septic shock and need for mechanical ventilation in patients with community-acquired pneumonia.
abstract: A subgroup of patients admitted to the hospital with a diagnosis of community-acquired pneumonia (CAP) have received antibiotic therapy prior to admission for the current episode of pneumonia. The objective of this study was to assess the clinical course of patients receiving antibiotics prior to admission, compared to patients not previously treated. An observational cohort of 3364 CAP patients consecutively admitted to our hospital, and prospectively included, were studied. We collected clinical, microbiological and biochemical parameters, focusing on recent antibiotics received prior to admission. 610 (18%) patients received antibiotics prior to hospital admission for the current CAP episode. Patients with previous antibiotic use developed septic shock less frequently (4% vs. 7%, p = 0.007) and required invasive ventilation less often (3% vs. 6%, p = 0.002). After adjustment by different covariate factors and propensity score, antibiotic therapy was still independently associated with a lower incidence of septic shock at admission (OR 0.54 [95% CI 0.31-0.95], p = 0.03) and less need for invasive ventilation (OR 0.38 [95% CI 0.16-0.91], p = 0.03). In this cohort, recent use of antibiotics before hospital admission in CAP seems to be associated with a lower incidence of septic shock on admission and a lower need for invasive ventilation.
authors.affiliation: Department of Pneumology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Rosanel
authors.initials: R
authors.lastname: Amaro
authors.affiliation: Department of Pneumology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Sellarés
authors.affiliation: Department of Pneumology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Polverino
authors.affiliation: Department of Pneumology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Catia
authors.initials: C
authors.lastname: Cillóniz
authors.affiliation: Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Fernández-Barat
authors.affiliation: Department of Infectious Disease, Hospital Clinic of Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Division of Pulmonary and Critical Care Medicine, New York Presbyterian- Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Niederman
authors.affiliation: Department of Pneumology, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Spain. Electronic address: atorres@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clinical course; Community-acquired pneumonia; Hospital admission; Previous antibiotic therapy