Abstract
Introduction: A significant proportion of patients who present to the Emergency Department with Community Acquired Pneumonia have been pre-treated with antibiotics in primary care. Little is known whether such patients carry a different outcome to those who are “antibiotic naive” pre-admission.
Aim: To test for association between “pre-hospital” antibiotic treatment and two measures of outcome: In-hospital mortality and Length Of Stay (LOS).
Methodology: We analysed the prospectively collected Advancing Quality (AQ) database of patients admitted with CAP to 9 acute hospitals in the Northwest of England between October 2015-16
Results: 6348 subjects (mean age 72 (SD 16) years; 50% male) were admitted with CAP during the study period. Of those, 17% (1059/6348) were pre-treated with antibiotics, 78% (4973/6348) were antibiotic naive and pre-treatment status was uncertain in 5% (316/6348). The in hospital mortality was 18.6% (197/1059) for the pre-treatment group compared to 13.2% (658/4973) in the antibiotic naive group (p<0.001) but no significant difference was observed in LOS (8.83 (11.1) v 9.41 (11.9) days; p<0.13). The Charlson Co-Morbidity index was significantly higher in the pre-treatment group (10.89 (10.54) v 9.70 (9.74)) but no significant differences were observed in age or CURB-65 between the groups.
Conclusion: In subjects requiring hospital admission for CAP, an increased mortality was noted in those who had received antibiotics pre-admission. Further studies are required to understand the mechanisms underlying this association and the benefit of pathways risk stratifying CAP by co-morbidity.
- Copyright ©the authors 2017