The impact of clinical guidelines on time to clinical stability, length of hospital stay, and mortality among nursing home patients hospitalized for pneumonia has not been previously studied.
Design: A retrospective cohort study. Setting: three tertiary hospitals.Participants: Three hundred thirty four nursing home patients.Measurements: Patients were classified according to the antibiotic regimens they have received based on either the 2003 community acquired pneumonia (CAP) guideline or the 2005 health-care associated pneumonia (HCAP) guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention to treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups.
Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability was achieved in 3.7± 0.7 days for the study cohort and did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (p=0.006) and multilobar involvement (p=0.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (OR 0.87; 95% CI 0.49–1.34, and OR 0.79; 95% CI 0.42–1.31, respectively) although the time to switch therapy and the length of stay were longer for those treated according to the 2005 HCAP guideline.
Among hospitalized nursing home patients with pneumonia, treatment with antibiotic regimen according to 2003 CAP guideline achieved comparable time to clinical stability, and in-hospital and 30-day mortality to a regimen based on 2005 HCAP guideline.
Antibiotic therapy for NHAP may be approached similar to CAP therapy in absence of risk factors for multidrug resistant pathogens.
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