Highlights
- •Guidelines do not assign a specific time frame for the first antibiotic dose in CAP
- •We evaluated the benefit of early antibiotics in moderately severe pneumonia
- •Time to treatment was not associated with a shorter time to clinical stability
- •These results should not be extrapolated to patients with more severe disease
Abstract
Background
The association between early antibiotic administration and outcomes remains controversial
in patients hospitalized for community-acquired pneumonia.
Methods
We performed a secondary analysis of a randomized controlled trial comparing two antibiotic
treatment strategies for patients hospitalized for moderately severe CAP. The univariate
and multivariate associations between time to antibiotic administration (TTA) and
time to clinical stability were assessed using a Cox proportional hazard model. Secondary
outcomes were death, intensive care unit admission and hospital readmission up to
90 days.
Results
371 patients (mean age 76 years, CURB-65 score ≥ 2 in 52%) were included. Mean TTA was 4.35 h (SD 3.48), with 58.5% of patients receiving the first antibiotic dose within 4 h.
In multivariate analysis, number of symptoms and signs (HR 0.876, 95% CI 0.784–0.979,
p = 0.020), age (HR 0.986, 95% CI 0.975–0.996, p = 0.007), initial heart rate (HR 0.992, 95% CI 0.986–0.999, p = 0.023), and platelets count (HR 0.998, 95% CI 0.996–0.999, p = 0.004) were associated with a reduced probability of reaching clinical stability.
The association between TTA and time to clinical stability was not significant (HR
1.009, 95% CI 0.977–1.042, p = 0.574). We found no association between TTA and the risk of intensive care unit admission,
death or readmission up to 90 days after the initial admission.
Conclusion
In patients hospitalized for moderately severe CAP, a shorter time to antibiotic administration
was not associated with a favorable outcome. These findings support the current recommendations
that do not assign a specific time frame for antibiotics administration.
Keywords
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Article info
Publication history
Published online: June 23, 2017
Accepted:
June 14,
2017
Received in revised form:
June 13,
2017
Received:
May 4,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
