A Comparison of Culture-Negative and Culture-Positive Health Care-Associated Pneumonia.

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.

Impact of Combination Antibiogram and Related Education on Inpatient Fluoroquinolone Prescribing Patterns for Patients With Health Care–Associated Pneumonia

“…Our data agree with previous reports suggesting that the current HCAP definition has poor sensitivity for patients most likely to harbor a resistant pathogen versus those who do not. 7,18,21 High rates of clinical and microbiological success were achieved throughout the study period, despite a reduction in FQ days and frequency of double coverage in the postintervention period.…”

“…Patients were included only if the following criteria were met ( a ) radiographic findings consistent with pneumonia plus 2 or more of the following signs of infection: temperature >100.4°F or <96.8°F, white blood cells >12 or <4 ×1000/µL, presence of cough or shortness of breath, and new or increased O 2 requirement; ( b ) presence of at least 1 guideline-concordant HCAP risk factor; ( c ) treated with ≥1 anti- Pseudomonas β-lactam initiated within 24 hours of admission. 18 Anti- Pseudomonas β-lactams were defined as piperacillin-tazobactam, cefepime, ceftazidime, meropenem, imipenem, doripenem, or aztreonam.…”

Emergency Pharmacist Impact on Health Care-Associated Pneumonia Empiric Therapy

“…Despite one previous HCAP study with culture negative data using the criteria of MRSA and single agent P aeruginosa coverage as their appropriate regimen, it was felt that double coverage was more in line with the guideline recommendations and consistent with multiple other HCAP studies analyzing empiric therapy. 1,5,13,14 In addition, it was decided that including culture negative data increased external validity as the majority of patients with HCAP do not have lower respiratory cultures drawn in the ED. 15…”

Characteristics and clinical outcomes of culture-negative and culture-positive septic shock: a single-center retrospective cohort study

“…Interestingly, lower respiratory and intra-abdominal infections were predominant in our culture-negative group, which suggests the site of infection may be associated with CNSS. Previous retrospective studies found that culture-positive patients with lung and intra-abdominal infections were associated with poor outcomes [23,24]. The authors thought that culture-negativity might imply susceptibility to the initial antibiotic regimens prescribed, leading to a lesser severity of illness.…”