TY - JOUR
T1 - Health care–associated pneumonia in the intensive care unit
T2 - Guideline-concordant antibiotics and outcomes
AU - Attridge, Russell T.
AU - Frei, Christopher R.
AU - Pugh, Mary Jo V
AU - Lawson, Kenneth A.
AU - Ryan, Laurajo
AU - Anzueto, Antonio
AU - Metersky, Mark L.
AU - Restrepo, Marcos I.
AU - Mortensen, Eric M.
N1 - Funding Information:
This project was supported by grant number R01NR010828 from the National Institute of Nursing Research . Dr. Mortensen was supported by Project Number 1R24HS022418-01 from the Agency for Health Care Research and Quality . Dr. Restrepo's time is partially protected by Award Number K23HL096054 from the National Heart, Lung, and Blood Institute . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health; the Department of Veterans Affairs; or the National Heart, Lung, and Blood Institute. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System and VA North Texas Health Care System. The funding agencies had no role in conducting the study or role in the preparation, review, or approval of the manuscript.
Funding Information:
Conflict of interest statements: Dr Frei has received grants outside the submitted work from Bristol Myers Squibb, Pfizer, and Ortho-McNeill Janssen. Dr Metersky has served as a consultant and clinical trial investigator for Bayer. Dr Restrepo's time is partially protected by award number K23HL096054 from the National Heart, Lung, and Blood Institute. Dr Mortensen reports grants from the National Institutes of Health received during the conduct of the study. Russell Attridge, Mary Jo Pugh, Kenneth Lawson, Laurajo Ryan, and Antonio Anzueto have nothing to report.
Publisher Copyright:
© 2016
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Purpose 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. Materials and methods 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. Results 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). Conclusions Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.
AB - Purpose 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. Materials and methods 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. Results 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). Conclusions Our data do not demonstrate improved outcomes among ICU patients with HCAP who received GC-HCAP therapy.
KW - Antibiotic therapy
KW - Critical care
KW - Guideline-concordant therapy
KW - Health outcomes
KW - Pneumonia
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U2 - 10.1016/j.jcrc.2016.08.004
DO - 10.1016/j.jcrc.2016.08.004
M3 - Article
C2 - 27595461
AN - SCOPUS:84994323503
SN - 0883-9441
VL - 36
SP - 265
EP - 271
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -