Time for first antibiotic dose is not predictive for the early clinical failure of moderate-severe community-acquired pneumonia

A. H. W. Bruns*, J. J. Oosterheert, W. N. M. Hustinx, C. A. J. M. Gaillard, E. Hak, A. I. M. Hoepelman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

The time to first antibiotic dose (TFAD) has been mentioned as an important performance indicator in community-acquired pneumonia (CAP). However, the advice to minimise TFAD to 4 hours (4 h) is only based on database studies. We prospectively studied the effect of minimising the TFAD on the early clinical outcome of moderate-severe CAP. On admission, patients' medical data and TFAD were recorded. Early clinical failure was expressed as the proportion of patients with clinical instability, admission to the intensive care unit (ICU) or mortality on day three. Of 166 patients included in the study, 27 patients (29.7%) with TFAD <4 h had early clinical failure compared to 23 patients (37.7%) with TFAD > 4 h (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.35-1.35). In multivariate analysis, the pneumonia severity index (OR 1.03; 95%CI 1.01-1.04), confusion (OR 2.63; 95%CI 1.14-6.06), Staphylococcus aureus infection (OR 7.26; 95%CI 1.33-39.69) and multilobar pneumonia (OR 2.40; 95%CI 1.11-5.22) but not TFAD were independently associated with early clinical failure. Clinical parameters on admission other than the TFAD predict early clinical outcome in moderate-severe CAP. In contrast to severe CAP necessitating treatment in the ICU directly, in the case of suspected moderate-severe CAP, there is time to establish a reliable diagnosis of CAP before antibiotics are administered. Therefore, the implementation of the TFAD as a performance indicator is not desirable.

Original languageEnglish
Pages (from-to)913-919
Number of pages7
JournalEuropean Journal of Clinical Microbiology & Infectious Diseases
Volume28
Issue number8
DOIs
Publication statusPublished - Aug-2009

Keywords

  • ANTIMICROBIAL-THERAPY
  • MEDICARE PATIENTS
  • GUIDELINES
  • MANAGEMENT
  • OUTCOMES
  • MORTALITY
  • QUALITY
  • CARE
  • PERFORMANCE
  • DELIVERY

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