RT Journal Article SR Electronic T1 Guideline-Concordant Therapy and Outcomes in Healthcare-Associated Pneumonia JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP erj01411-2010 DO 10.1183/09031936.00141110 A1 R.T. Attridge A1 C.R. Frei A1 M.I. Restrepo A1 K.A. Lawson A1 L. Ryan A1 M.J.V. Pugh A1 A. Anzueto A1 E.M. Mortensen YR 2011 UL http://erj.ersjournals.com/content/early/2011/03/21/09031936.00141110.abstract 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.