Atypical coverage in community-acquired pneumonia after outpatient beta-lactam monotherapy

Cornelis H. van Werkhoven*, Ewoudt M. W. van de Garde, Jan Jelrik Oosterheert, Douwe F. Postma, Marc J. M. Bonten

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

1 Citaat (Scopus)
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Introduction: In adults hospitalized with community-acquired pneumonia (CAP) after >48 h of outpatient beta-lactam monotherapy, coverage of atypical pathogens is recommended based on expert opinion.

Methods: In a post-hoc analysis of a large study of CAP treatment we included patients who received beta-lactam monotherapy for >48 h before hospitalization. Length of hospital stay (LOS), 30-day mortality, and number of treatment escalations were compared for those that continued beta-lactam monotherapy and those that received atypical coverage at admission.

Results: Of 179 patients (median age 66 years (IQR 50-78), 100 (56%) male), 131 (73%) received additional atypical coverage at admission. These patients were younger, had less comorbidities, and longer symptom duration, compared to those that continued beta-lactam monotherapy. In crude analysis, median (IQR) LOS was 6 (4-8) and 6 (4-9) days, mortality was 2% and 4%, and treatment escalations occurred in 8 (17%) and 11 (8%) patients without and with atypical coverage, respectively. Adjusted effect ratios for absence of atypical coverage on LOS, mortality, and treatment escalation were 0.77 (95% CI 0.61 -0.97), 0.37 (0.04-3.67), and 2.75 (0.94-8.09), respectively.

Conclusion: In adults hospitalized with CAP after >48 h of outpatient beta-lactam monotherapy, not starting antibiotics with atypical coverage was associated with a trend towards more treatment escalations, without evidence of increased LOS or mortality. (C) 2017 Elsevier Ltd. All rights reserved.

Originele taal-2English
Pagina's (van-tot)145-151
Aantal pagina's7
TijdschriftRespiratory Medicine
StatusPublished - aug-2017
Extern gepubliceerdJa

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