PURPOSE: Although the 2005 American Thoracic Society (ATS)/Infectious Disease Society of American (IDSA) antibiotic guidelines included pneumonia occurring in patients receiving chronic hemodialysis (HD) in the category of healthcare-associated pneumonia (HCAP), little data exists to support this classification. This study compares clinical outcomes in HD patients hospitalized with pneumonia who are treated according to the 2005 ATS/IDSA guidelines versus those treated according to guidelines recommending community-acquired antibiotic coverage.
METHODS: We retrospectively identified 300 patients admitted with the diagnosis of pneumonia and end-stage renal disease requiring hemodialysis. Patients were categorized into the community-acquired pneumonia (CAP) therapy group or the HCAP therapy group based on the antibiotic regimen they received. An intention-to-treat analysis was used to compare time-to-oral-therapy, length-of-stay, and mortality. A multivariate survival model using propensity analysis was used to adjust for variability within groups.
RESULTS: Data analysis suggest that, in our study population, pneumonia treated with CAP therapy will have comparable mortality to patients treated with HCAP therapy, and a decreased time-to-oral-therapy and length-of-stay.
CONCLUSIONS: Our data suggest that treating pneumonia in HD patients with CAP therapy may not be only safe but advantageous compared to broad spectrum multi-agent therapy as currently recomended by the IDSA/ATS guidelines.
CLINICAL IMPLICATIONS: Recognizing the inherent limitations of a small, retrospective study, our results call for further scientific evidence clarifying the role of chronic HD as a risk factor for multidrug resistant pneumonia.
DISCLOSURE: The following authors have nothing to disclose: Stephanie Pezzo, Brice Taylor, David Solomon
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