Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Definitions
2.3. Clinical and Laboratory Variables
2.4. Microbiological Evaluation
2.5. Clinical Outcomes
2.6. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Initial Clinical Features and Severity at Presentation
3.3. Isolation of Microorganisms
3.4. Empirical Antibiotic Therapy
3.5. Clinical Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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CAP | NHAP | ||
---|---|---|---|
Male, n (%) | 154 (49.2) | 100 (41.2) | p = 0.059 |
Median age, years (IQR) | 84 (77–88.5) | 87 (83–91) | p < 0.001 |
Katz scale, n (%) | p < 0.001 | ||
Independent | 99 (31.6%) | 10 (4.1) | |
Partially dependent | 117 (37.4%) | 70 (28,8) | |
Dependent | 97 (31%) | 163 (67.1) | |
Comorbidities, n (%) | |||
Heart failure | 160 (51.1) | 123 (50.6) | p = 0.907 |
Atrial fibrillation | 100 (31.9) | 69 (28.4) | p = 0.366 |
Chronic renal disease | 67 (21.4) | 59 (24.3) | p = 0.422 |
Diabetes mellitus | 103 (32.9) | 83 (34.2) | p = 0.757 |
COPD | 44 (14.1) | 27 (11.1) | p = 0.302 |
Hypertension | 226 (72.2) | 175 (72.0) | p = 0.961 |
CVD | 45 (14.4) | 74 (30.5) | p < 0.001 |
Chronic liver disease | 8 (2.6) | 0 (0.0) | p = 0.011 |
Active malignancy | 35 (11.2) | 15 (6.2) | p = 0.041 |
Immune suppression | 13 (4.2) | 12 (4.9) | p = 0.658 |
Antibiotic use (previous 6 months), n (%) | 126 (40.3) | 141 (58.0) | p < 0.001 |
CURB-65, n (%) | p < 0.001 | ||
0 | 5 (1.6) | 5 (1.6) | |
1 | 24 (7.7) | 24 (7.7) | |
2 | 76 (24.4) | 76 (24.4) | |
3 | 129 (41.3) | 129 (41.3) | |
4 | 65 (20.8) | 65 (20.8) | |
5 | 13 (4.2) | 13 (4.2) | |
Clinical features at admission | |||
Respiratory failure, n (%) | 229 (73.6) | 202 (83.1) | p = 0.008 |
Pleural effusion, n (%) | 64 (20.4) | 42 (17.1) | p = 0.346 |
Temperature, °C (IQR) | 37.2 (36.5–38.0) | 37.0 (36.3–37.6) | p = 0.004 |
Heart rate, bpm (IQR) | 85.5 (75.0–101.0) | 89.0 (76.0–102.0) | p = 0.370 |
Systolic blood pressure, mmHg (IQR) | 122.5 (107.3–141.0) | 116.5 (100.0–133.0) | p < 0.001 |
Non-invasive ventilation, n (%) | 25 (8.0) | 14 (5.8) | p = 0.308 |
Vasoactive amines, n (%) | 9 (2.9) | 4 (1.7) | p = 0.345 |
Laboratory values | |||
Leukocyte count, cells/µL(IQR) | 12,800 (9495–16,700) | 13,000 (9900–18,400) | p = 0.081 |
Neutrophil count, cells/µL (IQR) | 10,300 (7115–13,810) | 10,990 (7600–15,420) | p = 0.037 |
Creatinine, mg/dL (IQR) | 1.02 (0.76–1.61) | 1.05 (0.74–1.59) | p = 0.571 |
Urea, mg/dL (IQR) | 61.0 (41.0–93.6) | 67.2 (46.0–109.0) | p = 0.029 |
Haematocrit, % (IQR) | 37.0 (32.3–40.9) | 35.7 (31.7–40.3) | p = 0.180 |
Sodium, mEq/L (IQR) | 137.6 (135.0–140.9) | 138.3 (133.0–142.3) | p = 0.531 |
Albumin, g/L (IQR) | 34 (30–37) | 32 (28–35) | p < 0.001 |
LDH, U/L (IQR) | 361.0 (246.0–521–5) | 374.5 (249.3–542.5) | p = 0.627 |
Glucose, mg/dL (IQR) | 132 (109–171) | 138 (110–180) | p = 0.235 |
PaO2/FiO2 (IQR) | 266.7 (233.7–300.6) | 257.1 (206.7–300.0) | p = 0.080 |
PaCO2 (IQR) | 40.0 (35.0–48.0) | 41.0 (35.8–47.0) | p = 0.572 |
pH (IQR) | 7.46 (7.41–7.49) | 7.44 (7.39–7.48) | p = 0.254 |
Lactate, mmol/L (IQR) | 1.2 (0.8–1.8) | 1.3 (0.9–2.2) | p = 0.083 |
NT-proBNP, pg/mL (IQR) | 3065.2 (838.3–9832.5) | 2790.9 (889.5–10,675.0) | p = 0.956 |
C-reactive protein, mg/dL (IQR) | 12.5 (5.6–20.9) | 12.3 (6.7–19.5) | p = 0.848 |
Requested cultures and urinary antigen tests | |||
Blood culture, n (%) | 184 (58.8) | 149 (61.3) | p = 0.546 |
Sputum culture, n (%) | 33 (10.5) | 41 (16.9) | p = 0.029 |
S. pneumoniae urinary antigen test, n (%) | 41 (13.1) | 16 (6.6) | p = 0.012 |
Positive | 4 (10.8) | 2 (13.3) | p = 1.000 |
Legionella urinary antigen test, n (%) | 40 (12.8) | 15 (6.2) | p = 0.010 |
Positive | 1 (2.9) | 0 (0.0) | p = 1.000 |
Total | CAP | NHAP | |
---|---|---|---|
Positive blood culture, n (%) | 34 (51.5) | 17 (53.1) | 17 (50.0) |
Positive sputum culture, n (%) | 26 (39.4) | 12 (37.5) | 14 (41.2) |
Positive blood and sputum culture, n (%) | 6 (9.1) | 3 (9.4) | 3 (8.8) |
Total | 66 | 32 | 34 |
Gram-positive, n (%) | |||
Streptococcus pneumoniae | 3 (4.5) | 2 (6.3) | 1 (2.9) |
Staphylococcus aureus | 18 (27.3) | 8 (25.0) | 10 (29.4) |
Other Streptococcus species | 4 (6.1) | 2 (6.3) | 2 (5.9) |
Other Staphylococcus species | 1 (1.5) | 0 (0) | 1 (2.9) |
Enterococcus faecalis | 1 (1.5) | 1 (3.1) | 0 |
Gram-negative, n (%) | |||
Pseudomonas species | 6 (9.1) | 1 (3.1) | 5 (14.7) |
Klebsiella species | 8 (12.1) | 4 (12.5) | 4 (11.8) |
Escherichia coli | 11 (16.7) | 6 (18.8) | 5 (14.7) |
Haemophilus influenzae | 4 (6.1) | 4 (12.5) | 0 (0) |
Acinetobacter baumannii | 1 (1.5) | 1 (3.1) | 0 (0) |
Polymicrobial, n (%) | 9 (13.6) | 3 (9.4) | 6 (17.6) |
Resistance pattern | |||
Multidrug-sensitive, n (%) | 31 (47.0) | 20 (61.8) | 11 (36.1) |
Multidrug-resistant, n (%) | 20 (30.3) | 9 (29.4) | 11 (30.6) |
Extensively drug-resistant, n (%) | 15 (22.7) | 3 (8.8) | 12 (33.3) |
Total * | CAP | NHAP | |
---|---|---|---|
Non-MDRO coverage, n (%) | 360 | 222 (70.9) | 138 (57.0) |
Monotherapy | |||
Amoxicillin-clavulanate | 40 | 15 (4.8) | 25 (10.3) |
Ceftriaxone | 28 | 14 (4.5) | 14 (5.8) |
Cefuroxime | 3 | 3 (1.0) | 0 (0.0) |
Azithromycin | 2 | 1 (0.3) | 1 (0.4) |
Doxycycline | 1 | 1 (0.3) | 0 (0.0) |
Combination therapy | |||
Amoxicillin-clavulanate + azithromycin | 196 | 143 (45.8) | 53 (21.8) |
Ceftriaxone + azithromycin | 84 | 41 (13.1) | 43 (17.7) |
Cefuroxime + azithromycin | 3 | 2 (0.6) | 1 (0.4) |
Other combinations | 3 | 2 (0.6) | 1 (0.4) |
MDRO coverage, n (%) | 195 | 91 (29.1) | 104 (43.0) |
Monotherapy | |||
Trimethoprim/sulfamethoxazole | 6 | 2 (0.6) | 4 (1.6) |
Ceftazidime | 5 | 1 (0.3) | 4 (1.6) |
Ciprofloxacin | 1 | 1 (0.3) | 0 (0.0) |
Levofloxacin | 99 | 53 (16.9) | 46 (18.9) |
Meropenem | 6 | 4 (1.3) | 2 (0.8) |
Combination therapy | |||
Trimethoprim/sulfamethoxazole + ceftazidime | 3 | 1 (0.3) | 2 (0.8) |
Trimethoprim/sulfamethoxazole + piperacillin-tazobactam | 2 | 1 (0.3) | 1 (0.4) |
Piperacillin-tazobactam | 67 | 24 (7.7) | 43 (17.7) |
Piperacillin-tazobactam + vancomycin | 2 | 2 (0.6) | 0 (0.0) |
Meropenem + vancomycin | 1 | 1 (0.3) | 0 (0.0) |
Other combinations | 3 | 1 (0.3) | 2 (0.8) |
CAP | NHAP | ||
---|---|---|---|
Antibiotic failure, n (%) | 83 (26.5) | 88 (36.4) | p = 0.013 |
Readmission (30 days), n (%) | 44 (14.7) | 49 (21.7) | p = 0.037 |
Death, n (%) | |||
Admission until 30 days after discharge | 61 (19.5) | 79 (32.5) | p < 0.001 |
During hospitalization | 42 (13.4) | 52 (21.4) | p = 0.013 |
Days until death, n (IQR) | 11 (5–19) | 9 (4–16) | p = 0.165 |
Days of hospitalization, n (IQR) | 8 (5–15) | 6 (3–12) | p = 0.600 |
Antibiotic Failure | Univariable Logistic Regression | Multivariable Logistic Regression | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
NHAP | 1.583 | 1.102–2.276 | 0.013 | 1.083 | 0.726–1.616 | 0.696 |
Age | 1.042 | 1.019–1.065 | 0.000 | 1.031 | 1.008–1.055 | 0.008 |
Antibiotic use (previous 6 months) | 1.498 | 1.040–2.158 | 0.030 | 1.172 | 0.794–1.731 | 0.425 |
Katz scale | 0.835 | 0.772–0.903 | 0.000 | 0.867 | 0.792–0.949 | 0.002 |
Isolation of MDRO | Univariable Logistic Regression | Multivariable Logistic Regression | ||||
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
NHAP | 2.858 | 1.083–7.539 | 0.034 | 1.947 | 0.653–5.802 | 0.232 |
Age | 1.055 | 1.006–1.107 | 0.028 | 1.065 | 1.011–1.121 | 0.018 |
Antibiotic use (previous 6 months) | 4.143 | 1.429–12.012 | 0.009 | 4.275 | 1.316–13.890 | 0.016 |
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Lopes, M.; Alves Silva, G.; Nogueira, R.F.; Marado, D.; Gonçalves, J.; Athayde, C.; Silva, D.; Figueiredo, A.; Fortuna, J.; Carvalho, A. Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia. Infect. Dis. Rep. 2021, 13, 33-44. https://doi.org/10.3390/idr13010006
Lopes M, Alves Silva G, Nogueira RF, Marado D, Gonçalves J, Athayde C, Silva D, Figueiredo A, Fortuna J, Carvalho A. Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia. Infectious Disease Reports. 2021; 13(1):33-44. https://doi.org/10.3390/idr13010006
Chicago/Turabian StyleLopes, Mariana, Gonçalo Alves Silva, Rui Filipe Nogueira, Daniela Marado, João Gonçalves, Carlos Athayde, Dilva Silva, Ana Figueiredo, Jorge Fortuna, and Armando Carvalho. 2021. "Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia" Infectious Disease Reports 13, no. 1: 33-44. https://doi.org/10.3390/idr13010006
APA StyleLopes, M., Alves Silva, G., Nogueira, R. F., Marado, D., Gonçalves, J., Athayde, C., Silva, D., Figueiredo, A., Fortuna, J., & Carvalho, A. (2021). Incidence of Antibiotic Treatment Failure in Patients with Nursing Home-Acquired Pneumonia and Community Acquired Pneumonia. Infectious Disease Reports, 13(1), 33-44. https://doi.org/10.3390/idr13010006