ABSTRACT
BACKGROUND AND OBJECTIVE: The delay in the initiation of antibiotic treatment in patients with community-acquired pneumonia (CAP) could influence their prognostic. The aim of our study was to evaluate the influence of a delay in antibiotic treatment on mortality, occurrence of complications, and length of stay in the hospital, in relation to the prior duration of the fever. PATIENTS AND METHOD: This is a cohort study which includes all patients over 18 years of age admitted with CAP over a 4 year period. The response variables analysed were in-hospital mortality, average stay in days and occurrence of complications during evolution. The relationship between the delay in antibiotic treatment and the outcome variables was estimated by logistic regression models, adjusting the estimations by PSI (Pneumonia Severity Index) and APACHE II (Acute Physiology and Chronic Health Evaluation). RESULTS: Six hundred fifty-nine patients were included (average age of 71 years, 71% males). Seventy-six (11.6%) patients died, 12.1% of those who arrived after 48 hours (55.4% of patients) and 10.9% of those who came early. The delay in antibiotic treatment was associated with a higher mortality (odds ratio [OR] = 3.05; 95% confidence interval [CI], 0.86-10.9; threshold of 8 h), prolonged stay (OR = 2.38; CI 95%, 1.11-5.14; threshold of 5 h) and a higher rate of complications (OR = 2.24; CI 95%, 0.90-5.53; threshold of 3 h). CONCLUSIONS: Our results suggest the importance of the early administration of antibiotics in patients with CAP. There is also an increased risk for each of these outcomes in those patients with a history of fever of more than 2 days before arriving in hospital.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Pneumonia, Bacterial/drug therapy , Aged , Cohort Studies , Community-Acquired Infections/complications , Community-Acquired Infections/drug therapy , Community-Acquired Infections/mortality , Female , Humans , Length of Stay , Male , Pneumonia, Bacterial/complications , Pneumonia, Bacterial/mortality , Time FactorsABSTRACT
Fundamento y objetivo: La demora del tratamiento antibiótico en pacientes con neumonía adquirida en la comunidad (NAC) puede influir en su pronóstico. El objetivo del estudio ha sido estimar la influencia del retraso en el tratamiento antibiótico sobre la mortalidad, la estancia hospitalaria y la aparición de complicaciones, teniendo en cuenta la duración previa de la fiebre. Pacientes y método: Se trata de un estudio de cohortes en pacientes mayores de 18 años que ingresaron por NAC durante un período de 4 años. La relación entre la demora del tratamiento (para diferentes umbrales) y las variables de respuesta (mortalidad, estancia prolongada y complicaciones) se estimó mediante regresión logística, ajustando por la gravedad inicial. Resultados: Incluimos a 659 pacientes (un 71% varones), con una edad media de 71 años. Fallecieron 76 (11,6%), un 12,1% de los que acudieron con más de 2 días de fiebre (el 55,4% de los pacientes) y un 10,9% de los que acudieron precozmente. La demora del tratamiento antibiótico se asoció con un incremento de la mortalidad (odds ratio [OR] = 3,05; intervalo de confianza [IC] del 95%, 0,86-10,9; umbral de 8 h), una estancia prolongada (OR = 2,38; IC del 95%, 1,11-5,14; umbral de 5 h) y una mayor incidencia de complicaciones (OR = 2,24; IC del 95%, 0,90-5,53; umbral de 3 h). Las asociaciones fueron de mayor magnitud en los casos con fiebre de más de 48 h. Conclusiones: Nuestros resultados apoyan la importancia de la administración precoz de antibióticos en los pacientes con NAC. El incremento del riesgo es mayor si la demora del tratamiento se asocia a una duración previa de la fiebre superior a 2 días
Background and objective: The delay in the initiation of antibiotic treatment in patients with community-acquired pneumonia (CAP) could influence their prognostic. The aim of our study was to evaluate the influence of a delay in antibiotic treatment on mortality, occurrence of complications, and length of stay in the hospital, in relation to the prior duration of the fever. Patients and method: This is a cohort study which includes all patients over 18 years of age admitted with CAP over a 4 year period. The response variables analysed were in-hospital mortality, average stay in days and occurrence of complications during evolution. The relationship between the delay in antibiotic treatment and the outcome variables was estimated by logistic regression models, adjusting the estimations by PSI (Pneumonia Severity Index) and APACHE II (Acute Physiology and Chronic Health Evaluation). Results: Six hundred fifty-nine patients were included (average age of 71 years, 71% males). Seventy-six (11.6%) patients died, 12.1% of those who arrived after 48 hours (55.4% of patients) and 10.9% of those who came early. The delay in antibiotic treatment was associated with a higher mortality (odds ratio [OR] = 3.05; 95% confidence interval [CI], 0.86-10.9; threshold of 8 h), prolonged stay (OR = 2.38; CI 95%, 1.11-5.14; threshold of 5 h) and a higher rate of complications (OR = 2.24; CI 95%, 0.90-5.53; threshold of 3 h). Conclusions: Our results suggest the importance of the early administration of antibiotics in patients with CAP. There is also an increased risk for each of these outcomes in those patients with a history of fever of more than 2 days before arriving in hospital
