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Inpatient care of community-acquired pneumonia: RESULTS (1)

patients

Of the 2324 potentially eligible cases, approximately 70% from each era were reviewed (Figure 1). Of the 1682 (72%) potentially eligible cases reviewed, 698 eligible cases were identified and reviewed in full. Of the 984 ineligible cases, 416 (42%) were due to recent hospital discharge, 342 (35%) were due to coexisting infection, 108 (11%) did not meet either symptomatic or radiographic criteria for CAP and 118 (12%) were immune suppressed. Baseline and outcome data classified by secular period and guideline adherence are presented in Tables 1 and 2, respectively. Overall, the patients were elderly (median age 78 years) and had high illness severity (mean PSI score 116, risk class 4). Fifty-five patients (8%) were admitted to the intensive care unit at some time during hospitalization, while 40 patients (6%) were admitted to the intensive care unit within the first 24 h after admission. Median LOS was seven days, and in-hospital mortality was 9.2%.Analyses by guidelines

Overall, 636 cases (91%) were treated according to guidelines, with a nonsignificant increase in adherence between the early and recent periods (89% to 92%, P=0.20). Comparing guideline-adherent versus guideline-discordant cases, multivariable analysis found no significant association with mortality in the early or recent cohorts. Also, in guidelines-adherent patients, there was no difference in mortality between early and recent guidelines cohorts. No significant differences in LOS were observed in multivariable analyses comparing guideline-adherent with guideline-discordant cases in early or recent cohorts or between early and recent versions of guidelines. buy ortho tri-cyclen online

In multivariable analysis, guideline adherence was associated with 0.9 days fewer of IV antibiotics (95% CI 0.03 to 1.52, P=0.04) in the recent era. Recent cohort guideline-adherent cases had 1.8 days fewer of IV antibiotics (95% CI 1.5 to 2.1, P<0.0001) than early cohort guideline-adherent cases. Analogous multivariable analyses of antibiotic costs found a $5.70 lower cost (95% CI 3.20 to 7.84, P<0.0001) in recent versus early cohort guideline-adherent cases.

Figure 1) Case identification and selection. Approximately 70% of all cases identified in each era were randomly selected for review
Figure 1) Case identification and selection. Approximately 70% of all cases identified in each era were randomly selected for review

Table 1. Baseline patient data in a study examining the effect of antimicrobial guidelines on clinical outcomes and drug costs in Canadian teaching hospitals

Overall(n=698) Early cohort (n=280) Recent cohort (n=418) Pt
Guideline-adherent(n=250) Guideline-discordant(n=30) P* Guideline-adherent(n=386) Guideline-discordant(n=32) P*
Age in years (median [quartiles]) 78 78 72 0.005 78 72 0.007 0.12
Female sex (n [%]) 272 106 14 0.8 141 11 0.99 0.14
LTC residence (n [%]) 156 55 6 0.99 88 7 1 0.89
PSIt score (mean ± SD) 116±37 115±37 106±31 0.2 118±36 101±41 0.02 0.19
PSI class distribution (n [%])
1-3 179 71 12 0.24 82 14 0.002 0.12
4 301 102 11 175 12
5 218 77 7 128 6
Time to first antibiotic dose (h) 4 5 5 0.5 4 6 0.08 0.08
(median [quartiles])

*Comparison between guideline-adherent and guideline-discordant cases; tComparison between guideline-adherent cases in early versus recent cohorts; $Pneumonia severity index (PSI) . LTC Long-term care

Table 2. Treatment and outcome data classified by guideline adherence

Early cohort (n=280) Recent cohort (n=418)
Overall(n=698) Guideline-adherent(n=250) Guideline-discordant(n=30) P* Guideline-adherent(n=386) Guideline-discordant(n=32) P* Pt
Duration intravenous therapy in days (median [quartiles]) 3 4 3 0.18 1 3 (0.5, 6) 0.26 <0.0001
Antibiotic cost (median [quartiles]) $71.00($36.42, $130.08) $84.00 ($50.01, $148.68) $91.18 ($49.23, $185.44) 0.64 $63.00($30.58, $107.96) $85.56 ($29.42, $174.82) 0.23 <0.0001
Length of stay in days (median [quartiles]) 7 7 7 0.5 7 7 0.58 0.71
Mortality (n [%]) 64 (9.2) 26 (10.4) 0 0.09 34 (8.8) 4 (12.5) 0.52 0.59
Number of empirical antibiotics (%) 1 >2 525 173 169 81 10 20 0.0005 327 59 19 13 0.0007 <0.0001
Total number of antibiotics (%) 1 2>3 347 195 156 115 78 57 1 11 18 <0.0001 226 93 67 5 13    14     <0.0001 0.008