No abstract

Background:Health care−associated pneumonia (HCAP) has been associated with pathogens that are often multi−drug resistant and practice guidelines suggest initial treatment should be similar to hospital−acquired and ventilator−associated pneumonia. Objective: Describe the initial antibiotic treatment regimens, severity of illness, and in−hospital mortality among culture−negative (CN) and culture−positive (CP) patients with HCAP. Methods: A retrospective cohort study including 439 CN and 161 CP patients with HCAP admitted to Barnes−Jewish Hospital, St. Louis, MO from 2003−2005.Results: CN patients were more likely to receive an initial antibiotic regimen (ceftriaxone ± azithromycin or moxifloxacin) targeting community−acquired pneumonia (CAP) pathogens compared to CP patients (58% v. 32%, p < 0.001). Severity of illness, as described by ICU admission and the need for mechanical ventilation (MV) was greater in CP compared to CN patients (ICU admit 46% v. 15%, p<0.001; MV 43% v. 10%, p <0.001). In−hospital mortality was statistically similar amongst CN and CP patients (10% v. 14%, p = 0.150). Conclusion: In this analysis, CN HCAP patients demonstrated a lower severity of illness and were more likely to receive an initial antibiotic regimen targeting CAP pathogens. In−hospital mortality rates do not differ between patients with CN and CP HCAP. This abstract is funded by: None.

No abstract