Author(s): Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG
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Abstract BACKGROUND: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital. METHODS: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS). RESULTS: Among 13 771 (75.6\%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8\% vs 7.4\%; adjusted odds ratio [AOR], 0.85; 95\% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6\% vs 12.7\%; AOR, 0.85; 95\% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1\% vs 45.1\%; AOR, 0.90; 95\% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9\% of all patients and for more than 50\% of patients regardless of hospital characteristics. CONCLUSIONS: Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.
This article was published in Arch Intern Med
and referenced in Pharmaceutica Analytica Acta