Antimicrobial selection for hospitalized patients with presumed community-acquired pneumonia: A survey of nonteaching US community hospitals

OBJECTIVE: To describe and evaluate empiric antimicrobial regimens chosen f or hospitalized patients with presumed community-acquired pneumonia (CAP) i n US hospitals, including compliance with the American Thoracic Society (AT S) guidelines. Secondary outcomes included length of stay (LOS) and mortali ty associated with the choice of therapy. METHODS: A nonrandomized, prospective, observational study was performed in 72 nonteaching hospitals affiliated with a national group purchasing organ ization. Patients with an admission diagnosis of physician-presumed CAP and an X-ray taken within 72 hours of admission were eligible for the study. D emographic, antibiotic selection, and outcomes data were collected prospect ively from patient charts. RESULTS: 3035 patients were enrolled; 2963 were eligible for analysis. Comp liance with the ATS guidelines was 81% in patients with nonsevere CAP. The most common antibiotic regimen used for empiric treatment was ceftriaxone a lone or in combination with a macrolide (42%). The overall mortality rate w as 5.5%. The addition of a macrolide to either a second- or third-generatio n cephalosporin or a beta-lactam/beta-lactamase inhibitor was associated wi th decreased mortality and reduced LOS. CONCLUSIONS: Most hospitalized patients with GAP receive antimicrobial ther apy consistent with the ATS guidelines. The addition of a macrolide may be associated with improved patient outcomes.