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Delayed Administration of Antibiotics and Mortality in Patients With Community-Acquired Pneumonia

Cheng, Allen C. and Buising, K. L. (2009). Delayed Administration of Antibiotics and Mortality in Patients With Community-Acquired Pneumonia. Annals of Emergency Medicine,53(5):618-624.

Document type: Journal Article
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Title Delayed Administration of Antibiotics and Mortality in Patients With Community-Acquired Pneumonia
Author Cheng, Allen C.
Buising, K. L.
Journal Name Annals of Emergency Medicine
Publication Date 2009
Volume Number 53
Issue Number 5
ISSN 1097-6760   (check CDU catalogue  open catalogue search in new window)
Start Page 618
End Page 624
Total Pages 7
Place of Publication US
Publisher Mosby, Inc.
HERDC Category C1 - Journal Article (DEST)
Abstract Study objective
Previous studies have demonstrated a crude association between the time to first antibiotic dose and mortality in patients with community-acquired pneumonia. We hypothesize that time to first antibiotic dose may affect mortality, particularly for patients at high risk of death, that is, patients hypoxic on presentation, patients in Pneumonia Severity Index class IV or V, and patients older than 65 years at our institution.

Methods
We reviewed data from a prospectively collected database of patients with community-acquired pneumonia, excluding patients who had received antibiotics before presentation and palliative patients not receiving antibiotics. We examined time to first antibiotic dose in patients who died or had prolonged length of stay (all patients) and in specific subgroups regarded as high risk (age >65 years, Pneumonia Severity Index class IV or V, presence of hypoxia or hypotension).

Results
In 501 patients, the median time to first antibiotic dose was 2.7 hours, with 91% of patients receiving antibiotics within 8 hours. Time to first antibiotic dose was not positively associated with mortality or prolonged length of stay in any of the subgroups examined. We found evidence that patients with severe pneumonia received antibiotics earlier than other patients.

Conclusion
Most patients at this institution already receive timely antibiotic therapy. This finding may be due to either a true lack of association, in that minor delays in antibiotic administration, where antibiotics are generally administered within 8 hours, do not affect mortality. Additionally, there may be confounding by severity, such that patients at highest risk of death received antibiotics earlier.
DOI http://dx.doi.org/10.1016/j.annemergmed.2008.07.017   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Thu, 18 Mar 2010, 19:57:22 CST by Sarena Wegener