RT Journal
A1 Gleason PP, Meehan TP, Fine JM, Galusha DH, Fine MJ
T1 ASsociations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD November 22
VO 159
IS 21
SP 2562
OP 2572
DO 10.1001/archinte.159.21.2562
UL http://dx.doi.org/10.1001/archinte.159.21.2562
AB Background 
    Although medical practice guidelines exist, there have been no large-scale studies assessing the relationship between initial antimicrobial therapy and medical outcomes for patients hospitalized with pneumonia.Objective 
    To determine the associations between initial antimicrobial therapy and 30-day mortality for these patients.Methods 
    Hospital records for 12,945 Medicare inpatients (≥65 years of age) with pneumonia were reviewed. Associations between initial antimicrobial regimens and 30-day mortality were assessed with Cox proportional hazards models, adjusting for baseline differences in patient characteristics, illness severity, and processes of care. Comparisons were made with patients treated with a non-pseudomonal third-generation cephalosporin alone (the reference group).Results 
    Initial treatment with a second-generation cephalosporin plus macrolide (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.52-0.96), a non-pseudomonal third-generation cephalosporin plus macrolide (HR, 0.74; 95% CI, 0.60-0.92), or a fluoroquinolone alone (HR, 0.64; 95% CI, 0.43-0.94) was independently associated with lower 30-day mortality. Adjusted mortality among patients initially treated with these 3 regimens became significantly lower than that in the reference group beginning 2, 3, and 7 days, respectively, after hospital admission. Use of a β-lactam/β-lactamase inhibitor plus macrolide (HR, 1.77; 95% CI, 1.28-2.46) and an aminoglycoside plus another agent (HR, 1.21; 95% CI, 1.02-1.43) were associated with an increased 30-day mortality.Conclusions 
    In this study of primarily community-dwelling elderly patients hospitalized with pneumonia, 3 initial empiric antimicrobial regimens were independently associated with a lower 30-day mortality. The more widespread use of these antimicrobial regimens is likely to improve the medical outcomes for elderly patients with pneumonia.