Administration of first hospital antibiotics for community-acquired pneumonia: does timeliness affect outcomes?

Abstract

A significant and causal relationship appears to exist between antibiotic timing and improved outcomes, especially among older patients. Even modest improvements in timeliness of antibiotic administration could impact a substantial number of lives because of the high incidence of community-acquired pneumonia hospitalization.

Severe community‐acquired pneumonia treated with β‐lactam–respiratory quinolone vs. β‐lactam–macrolide combination

“…Concerning positive blood cultures, the bQ and bM groups did not differ statistically (P = 0.495). When severity scores were compared between groups, median APACHE II score on admission was lower in the bQ group: 18 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) vs. 22 (13-26) (P = 0.003). There were no differences between groups for PIRO score [3 (2-4) vs. 3 (2-4); P = 0.71], 24 h SOFA score [7 (4-10) vs. 7 (3-9); P = 0.40], or SOFA max score [8 (5-11) vs. 7 (4-10); P = 0.15], respectively.…”

Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measure

“…Two smaller studies of CAP found no association between early antibiotic administration and outcomes (10,11). Nevertheless, the authors of the 2004 study (9) editorialized that the 4-hour TFAD quality measure was still valid (12,13). …”

Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus: Does Vancomycin Heteroresistance Matter?

“…In contrast, DeRyke et al reported no significant difference in inpatient mortality rates among VAP patients that received timely versus delayed appropriate antibiotic therapy (42). Evidence in community-acquired pneumonia (CAP) also fails to demonstrate consistent conclusions (41,43,44). Timely administration of appropriate antibiotics has been previously demonstrated in MRSA BSI (45).…”

“…Previous publications have related delayed appropriate therapy in the setting of pneumonia to increased mortality (5,41). In a recent publication by Inchai et al, late antibiotic therapy (Ͼ24 h) was associated with a hazard ratio of 2.23 (95% CI, 1.12 to 4.45; P ϭ 0.022) among a single-center cohort of patients diagnosed with VAP (6).…”