Abstract
Purpose: To assess the frequency and identify the factors involved in changing empiric antibiotics during the treatment of community acquired pneumonia (CAP).
Methods: Retrospective study including all patients admitted to a pulmonology ward of a Portuguese tertiary hospital with primary diagnosis of CAP from January to October 2013. Socio-demographic variables, smoking status and pack-years of smoking, comorbidities, CURB65, laboratory and radiologic findings on admission, microbiologic findings and length of hospital stay were recorded. All p-values <0.05 were considered statistically significant.
Results: One hundred and twenty patients were included (mean age 62.4±14.6 years, 82 male, 38 female). The empirical treatment adopted in 96.7% of patients was consistent with international guidelines. Modification of empirical antibiotic treatment occurred in 35 (29.2%) cases, conditioned by lack of clinical response in 30 (85.7%) cases and isolation of a microorganism not covered by treatment in 3 (8.6%). Overall mortality rate was 0.8%. Length of stay was associated with modification of antibiotic therapy (p<0.001). No other individual factor was significantly associated with modification of empirical antibiotic therapy in CAP.
Conclusion: Attending to the low rates of etiological diagnosis in CAP patients, an adequate empirical therapy is crucial for a good outcome in these patients. In our study, almost 30% of patients needed a modification of empirical therapy, due mainly to clinical reasons. The individual factors involved in this change process remained uncertain in our population.
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