Comparison of Clinical Effects between Different Initial Antibiotic Treatments for Health Care-associated Pneumonia_West China Medical Journal

Authors：

 ZHOUYi-wu , MENGXiao-yan , LILing ,  CAOYu

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

CAOYu, Email: dr.yu.cao@gmail.com

Keywords：

Health care-associated pneumonia; Antibiotics; Clinical effect

DOI：

10.7507/1002-0179.20150291

Video：

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Objective To analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). Method A retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. Results In group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). Conclusions It is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.

Citation： ZHOUYi-wu, MENGXiao-yan, LILing, CAOYu. Comparison of Clinical Effects between Different Initial Antibiotic Treatments for Health Care-associated Pneumonia. West China Medical Journal, 2015, 30(6): 1011-1014. doi: 10.7507/1002-0179.20150291 Copy

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10.	European Society of Clinical Microbiology and Infectious Diseases, European Respiratory Society. Guidelines for the management of adult lower respiratory tract infections[J]. Clin Microbiol Infect, 2011, 17(Suppl6):1-59.
11.	Carratalà J, Mykietiuk A, Fernández-Sabé N, et al. Health care-associated pneumonia requiring hospital admission:epidemiology, antibiotic therapy, and clinical outcomes[J]. Arch Intern Med, 2007, 167(13):1393-1399.
12.	Park SC, Kang YA, Park BH, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia[J]. Respir Med, 2012, 106(9):1311-1319.
13.	Kawasaki S, Aoki N, Kikuchi H, et al. Clinical and microbiological evaluation of hemodialysis-associated pneumonia (HDAP):should HDAP be included in healthcare-associated pneumonia?[J]. J Infect Chemother, 2011, 17(5):640-645.
14.	Jung JY, Park MS, Kim YS, et al. Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital[J]. BMC Infect Dis, 2011, 11:61.
15.	Falcone M, Corrao S, Venditti M, et al. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia[J]. Intern Emerg Med, 2011, 6(5):431-436.
16.	Jeong BH, Koh WJ, Yoo H, et al. Performances of prognostic scoring systems in patients with healthcare-associated pneumonia[J]. Clin Infect Dis, 2013, 56(5):625-632.
17.	Garcia-Vidal C, Viasus D, Roset A, et al. Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization[J]. Clin Microbiol Infect, 2011, 17(11):1659-1665.
18.	Taylor SP, Taylor BT. Health care-associated pneumonia in hemodialysis patients:clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy[J]. Respirology, 2013, 18(2):364-368.
19.	Maruyama T, Niederman MS, Kobayashi T, et al. A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly[J]. Respir Med, 2008, 102(9):1287-1295.
20.	Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial[J]. JAMA, 2006, 295(21):2503-2510.

1. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2005, 171(4):388-416.
2. Shindo Y, Ito R, Kobayashi D, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med, 2013, 188(8):985-995.
3. Nakagawa N, Saito Y, Sasaki M, et al. Comparison of clinical profile in elderly patients with nursing and healthcare-associated pneumonia, and those with community-acquired pneumonia[J]. Geriatr Gerontol Int, 2014, 14(2):362-371.
4. Umeki K, Tokimatsu I, Yasuda C, et al. Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital:comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia[J]. Respirology, 2011, 16(5):856-861.
5. Viasus D, Garcia-Vidal C, Cruzado JM, et al. Epidemiology, clinical features and outcomes of pneumonia in patients with chronic kidney disease[J]. Nephrol Dial Transplant, 2011, 26(9):2899-2906.
6. Micek ST, Kollef KE, Reichley RM, et al. Health care-associated pneumonia and community-acquired pneumonia:a single-center experience[J]. Antimicrob Agents Chemother, 2007, 51(10):3568-3573.
7. Rello J, Luján M, Gallego M, et al. Why mortality is increased in health-care-associated pneumonia:lessons from pneumococcal bacteremic pneumonia[J]. Chest, 2010, 137(5):1138-1144.
8. Attridge RT, Frei CR, Restrepo MI, et al. Guideline-concordant therapy and outcomes in healthcare-associated pneumonia[J]. Eur Respir J, 2011, 38(4):878-887.
9. Cao G, Chen X, Wu S. Analysis of clinical efficacy of different initial antimicrobial treatment in healthcare associated pneumonia patients in emergency department[J].Chin Med J (Engl), 2014, 127(10):1814-1819.
10. European Society of Clinical Microbiology and Infectious Diseases, European Respiratory Society. Guidelines for the management of adult lower respiratory tract infections[J]. Clin Microbiol Infect, 2011, 17(Suppl6):1-59.
11. Carratalà J, Mykietiuk A, Fernández-Sabé N, et al. Health care-associated pneumonia requiring hospital admission:epidemiology, antibiotic therapy, and clinical outcomes[J]. Arch Intern Med, 2007, 167(13):1393-1399.
12. Park SC, Kang YA, Park BH, et al. Poor prediction of potentially drug-resistant pathogens using current criteria of health care-associated pneumonia[J]. Respir Med, 2012, 106(9):1311-1319.
13. Kawasaki S, Aoki N, Kikuchi H, et al. Clinical and microbiological evaluation of hemodialysis-associated pneumonia (HDAP):should HDAP be included in healthcare-associated pneumonia?[J]. J Infect Chemother, 2011, 17(5):640-645.
14. Jung JY, Park MS, Kim YS, et al. Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital[J]. BMC Infect Dis, 2011, 11:61.
15. Falcone M, Corrao S, Venditti M, et al. Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia[J]. Intern Emerg Med, 2011, 6(5):431-436.
16. Jeong BH, Koh WJ, Yoo H, et al. Performances of prognostic scoring systems in patients with healthcare-associated pneumonia[J]. Clin Infect Dis, 2013, 56(5):625-632.
17. Garcia-Vidal C, Viasus D, Roset A, et al. Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization[J]. Clin Microbiol Infect, 2011, 17(11):1659-1665.
18. Taylor SP, Taylor BT. Health care-associated pneumonia in hemodialysis patients:clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy[J]. Respirology, 2013, 18(2):364-368.
19. Maruyama T, Niederman MS, Kobayashi T, et al. A prospective comparison of nursing home-acquired pneumonia with hospital-acquired pneumonia in non-intubated elderly[J]. Respir Med, 2008, 102(9):1287-1295.
20. Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia:a randomized controlled trial[J]. JAMA, 2006, 295(21):2503-2510.

West China Medical Journal

Comparison of Clinical Effects between Different Initial Antibiotic Treatments for Health Care-associated Pneumonia

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