Empiric antibiotic therapy of community-acquired Pneumonia at the American University of Beirut Medical Center. (c2001)

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.