Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Results
Of the 543 patients identified with S pneumoniae-positive blood and/or respiratory culture findings, 168 patients met inclusion/exclusion criteria. Patients were excluded from the analysis for the following reasons: 203 patients had HIV infection, 72 patients did not meet clinical criteria or did not have a positive chest radiographic finding, 65 patients were discharged from the emergency department or admitted to the hospital for < 2 days, and 35 patients were infected with another bacteria at baseline other than those allowed in the inclusion/exclusion criteria. cheap wellbutrin
Overall, patients were elderly (mean age, 63 years) and were equally divided among male and female gender (Table 1). Twenty-seven percent of patients were directly admitted to the ICU, and 42% had bacteremic pneumonia. The high severity of illness of this population was also apparent in the PSI score with 33% of patients in class IV and 23% in class V. Penicillin susceptibility was 74%; 11% were intermediate resistant, and 16% displayed high-level resistance. Crude mortality was 13% but was 21% among subjects within PSI classes IV and V. Ninety-five percent of patients who died were in PSI classes IV and V; one patient in PSI class III also died.
There were no significant differences in patient demographics or clinical characteristics when the cohort was divided by penicillin susceptibility except for bacteremic pneumonia, which was more common among patients infected with penicillin susceptible isolates (48% vs 25%, p = 0.012). Lastly, penicillin susceptibility did not affect the median hospital length of stay for patients, which was 6 days in both groups (p = 0.725), nor did it influence admission to an ICU (p = 0.497). However, patients admitted to the ICU did have a significantly longer median length of stay (11.0 days [25th to 75th percentile, 6.8 to 19.8 days] vs 5.0 days [25th to 75th percentile, 4.0 to 8.0 days]; p < 0.001) compared with those treated outside the ICU.
Table 2 displays the list of antibiotic regimens utilized to empirically treat CAP in these patients for at least the first 24 h. The majority of patients received a (3-lactam as monotherapy (32.7%), or in combination with a macrolide (32.7%), or monotherapy with a fluoroquinolone (9.5%). The remaining 25% of patients received alternative regimens, but in all but 4.8% of cases, a (3-lactam, macrolide, or fluoroquinolone was utilized as at least one of the drugs in the regimen.
Table 1—Patient Demographic and Clinical Characteristics for All Patients With CAP Caused by S pneumoniae and Then Comparable Results for Groups Defined by Penicillin Susceptibility
Characteristics | All Patients(n = 168) | Patients With Penicillin-Susceptible S pneumoniae (n = 124) | Patients with Penicillin-Nonsusceptible S pneumoniae (n = 44) | p Valuef |
Age, yr | 63 ± 19 | 63 ± 18 | 63 ± 19 | 0.983 |
Male gender | 88 (52) | 64 (52) | 24 (55) | 0.874 |
Admission to ICU | 45 (27) | 31 (25) | 14 (32) | 0.497 |
Bacteremic pneumonia | 71 (42) | 60 (48) | 11 (25) | 0.012 |
PSI score | ||||
I | 13(8) | 11 (9) | 2(5) | 0.677 |
II | 23 (14) | 17(14) | 6 (14) | |
III | 38 (23) | 26 (21) | 12 (27) | |
IV | 55 (33) | 43 (35) | 12 (27) | |
V | 39 (23) | 27 (22) | 12 (27) | |
Median (25th to 75th percentile) | 6 (4-10) | 6 (4-10.5) | 6 (4-9.5) | 0.725 |
hospital length of stay, d | ||||
Penicillin susceptibility | ||||
Susceptible | 124(74) | 124 (100) | ND | |
Intermediate | 18(11) | 18(41) | ||
Resistant | 26 (16) | 26 (59) | ||
Comorbid conditions | ||||
Diabetes | 39 (23) | 27 (22) | 12 (27) | 0.593 |
COPD | 46 (27) | 37 (30) | 9 (20) | 0.316 |
CHF | 26 (15) | 15 (12) | 11 (25) | 0.073 |
Neoplasm | 21 (13) | 17(14) | 4 (9) | 0.596 |
Liver disease | 14(8) | 11 (9) | 3 (7) | 0.916 |
Admission year | ||||
1999 | 28 (17) | 17(14) | 11 (25) | 0.441 |
2000 | 47 (28) | 35 (28) | 12 (27) | |
2001 | 37 (22) | 27 (22) | 10 (23) | |
2002 | 51 (30) | 41 (33) | 10 (23) | |
2003 | 5 (3) | 4(3) | 1(2) | |
Crude mortality | 21 (13) | 17(14) | 4 (9) | 0.596 |
Table 2—Empiric Antibiotic Regimens Utilized for > 24 h
Antibiotic Regimens | No. (%) |
Р-Lactam monotherapy* | 55 (32.7) |
Р-Lactam plus macrolide | 55 (32.7) |
Fluoroquinolone monotherapy | 16 (9.5) |
Р-Lactam plus vancomycin | 8 (4.8) |
Р-Lactam plus macrolide plus fluoroquinolone | 7 (4.2) |
Р-Lactam plus clindamycin | 6 (3.6) |
Macrolide monotherapy | 5 (3.0) |
Р-Lactam plus macrolide plus vancomycin | 3(1.8) |
Р-Lactam plus fluoroquinolone | 3(1.8) |
Macrolide plus fluoroquinolone | 2(1.1) |
Other | 8 (4.8) |