Abstract
Aim: To compare clinical, microbiological, severity and outcomes in patients with CAP admitted to hospital who had received or not previous antibiotic treatment.
Method: A 12 months prospective multicenter study was performed in Valenciana Community, in Spain (mediterranean area). Factors related comorbidity, etiology, severity, outcomes and mortality, were analyzed. Patients were divided in Group A: antibiotic treatment before admission and Group B: no previous antibiotic treatment.
Results: 1313 CAP, 850 men (65%), 295 in group A (22.4%) with previous antibiotics during 4.3±2.8 days. Patients in group A were younger (59±20 vs 65±18, p <0.001), and more patients treated like outpatients (13.2% vs 8.8%, p<0.05) without differences in residence. When risk factors and comorbidity were analyzed, in group A there were lower proportion of alcohol abuse, heart failure (p<0.05) and CAP evolution days (7±4 vs 5±5, p<0.001), without differences in other factors. In clinical presentation, group A had more fever and cough (p<0.001), lesser dyspnea, and altered mental status (p<0.05), with higher PaO2/FiO2 (293±255 vs 281±69, p<0.05). No differences in radiology pattern between groups or in etiological confirmation were found. Patients in group A had a lower PSI (81±36 vs 92±35, p<0.001), lower rate of complications (p=0,005) as renal failure, shock, mechanical ventilation and ICU admission (p<0.05), without differences in intrahospital mortality. The length of stay was shorter in group A (9±5 vs 11±10 days, p<0.001).
Conclusions: Patients with CAP who received antibiotic treatment before admission were younger, required less hospitalization and the CAP had less severity and complications.
- © 2011 ERS