PT  - JOURNAL ARTICLE
AU  - R.T. Attridge
AU  - C.R. Frei
AU  - M.I. Restrepo
AU  - K.A. Lawson
AU  - L. Ryan
AU  - M.J.V. Pugh
AU  - A. Anzueto
AU  - E.M. Mortensen
TI  - Guideline-Concordant Therapy and Outcomes in Healthcare-Associated Pneumonia
AID  - 10.1183/09031936.00141110
DP  - 2011 Jan 01
TA  - European Respiratory Journal
PG  - erj01411-2010
4099  - http://erj.ersjournals.com/content/early/2011/03/21/09031936.00141110.short
4100  - http://erj.ersjournals.com/content/early/2011/03/21/09031936.00141110.full
AB  - Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality in HCAP patients treated with either guideline-concordant HCAP (GC-HCAP) therapy or guideline-concordant community-acquired pneumonia (GC-CAP) therapy.We performed a population-based cohort study of >150 hospitals in the U.S. Veterans Health Administration. Patients were included if they had ≥1 HCAP risk factor and received antibiotic therapy within 48 hours of admission. Critically-ill patients were excluded. Independent risk factors for 30-day mortality were determined in a generalized linear mixed-effect model, with admitting hospital as a random effect. Propensity scores for the probability to receive GC-HCAP therapy were calculated and incorporated into a second logistic regression model.A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%), or non-guideline-concordant therapy (16.3%). The strongest predictors of 30-day mortality were recent hospital admission (OR 2.49, 95% CI 2.12–2.94) and GC-HCAP therapy (2.18, 1.86–2.55). GC-HCAP therapy remained an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82–2.48) in the propensity score analysis.In non-severe HCAP patients, GC-HCAP therapy is not associated with improved survival compared to GC-CAP therapy.