Abstract:
The emergence of resistance among Streptococcus pneumoniae strains have led to
the development of several guidelines for the treatment of community-acquired
Pneumonia (CAP). Our purpose is to compare CAP empiric treatment practices
in patients hospitalized at a tertiary care medical center to those of the Infectious
Disease Society of America guidelines. In a six-month period, patients over 18
years of age were included in a prospective open label observational study if a
clinician documented an initial working diagnosis of pneumonia or if a chest xray
performed within the first 48 hours of hospitalization is reported consistent
with pneumonia. Patients were excluded if they were HIV positive, neutropenic,
had been hospitalized within the previous 10 days, had a history of organ transplant, had been exposed to chemotherapy or immunosuppressive therapy
within the previous two month, had been transferred from another acute care
facility. Hospitalization need per the Pneumonia Port criteria was evaluated; in
addition to the initial antimicrobial regimen, course of treatment, microbiology,
and outcome. Initial antimicrobial regimen was defined as all antibiotics used
during the first 48 hours of hospitalization. Outcome variables evaluated were
the length of stay, success or failure of therapy. Success of therapy was defined
as improvement in clinical or objective parameters. Failure was considered if the patient's antimicrobial regimen was changed or if there is clinical deterioration
from baseline.
65 eligible patients were identified with a mean age of 62.5 ± 18 years. 63 patients
were treated in the medical ward and two patients in the intensive care unit. Per
the pneumonia PORT prediction rule, there was overhospitalization by 50% .41
patients received single therapy regimen with Levofloxacin being the most used
single agent (51 %). The remaining 24 patients received combination therapy
primarily using a third generation cephalosporin (not Ceftazidime) with a
macrolide (75%). Success rate was 87.8% and 90.9% in single and combination
therapy groups respectively. Microbiological yield was very low for both sputum
and blood samples. In most of the cases, initial antibiotic regimen at AUBMC was appropriate and in
accordance with the IDSA guidelines. Special attention should be given to
decrease hospitalization rate, to preserve fluoroquinolones, and to improve
microbiological studies outcome.
