Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia
- PMID: 15006826
- DOI: 10.1001/archinte.164.5.502
Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia
Abstract
Background: Early failure is a matter of great concern in the treatment of community-acquired pneumonia. However, information on its causes and risk factors is lacking.
Methods: Observational analysis of a prospective series of 1383 nonimmunosuppressed hospitalized adults with community-acquired pneumonia. Early failure was defined as lack of response or worsening of clinical or radiologic status at 48 to 72 hours requiring changes in antibiotic therapy or invasive procedures. Concordance of antimicrobial therapy was examined for cases with an etiologic diagnosis.
Results: At 48 to 72 hours, 238 patients (18%) remained febrile, but most of them responded without further changes in antibiotic therapy. Eighty-one patients (6%) had early failure. The main causes of early failure were progressive pneumonia (n = 54), pleural empyema (n = 18), lack of response (n = 13), and uncontrolled sepsis (n = 9). Independent factors associated with early failure were older age (>65 years) (odds ratio [OR], 0.35), multilobar pneumonia (OR, 1.81), Pneumonia Severity Index score greater than 90 (OR, 2.75), Legionella pneumonia (OR, 2.71), gram-negative pneumonia (OR, 4.34), and discordant antimicrobial therapy (OR, 2.51). Compared with treatment responders, early failures had significantly higher rates of complications (58% vs 24%) and overall mortality (27% vs 4%) (P<.001 for both).
Conclusions: Early failure is infrequent but is associated with high morbidity and mortality rates. Its detection and management require careful clinical assessment. Most cases occur because of inadequate host-pathogen responses. Discordant therapy is a less frequent cause of failure, which may be preventable by rational application of the current antibiotic guidelines.
Similar articles
-
Early and late treatment failure in community-acquired pneumonia.Semin Respir Crit Care Med. 2009 Apr;30(2):154-60. doi: 10.1055/s-0029-1202934. Epub 2009 Mar 18. Semin Respir Crit Care Med. 2009. PMID: 19296415 Review.
-
Risk factors and outcome of community-acquired pneumonia due to Gram-negative bacilli.Respirology. 2009 Jan;14(1):105-11. doi: 10.1111/j.1440-1843.2008.01371.x. Respirology. 2009. PMID: 18699803
-
Evidence-based emergency medicine/critically appraised topic. Evidence behind the 4-hour rule for initiation of antibiotic therapy in community-acquired pneumonia.Ann Emerg Med. 2008 May;51(5):651-62, 662.e1-2. doi: 10.1016/j.annemergmed.2007.10.022. Epub 2008 Feb 13. Ann Emerg Med. 2008. PMID: 18272253 Review.
-
Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia.Clin Infect Dis. 2008 Feb 15;46(4):550-6. doi: 10.1086/526526. Clin Infect Dis. 2008. PMID: 18194099
-
Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.Thorax. 2004 Nov;59(11):960-5. doi: 10.1136/thx.2003.017756. Thorax. 2004. PMID: 15516472 Free PMC article.
Cited by
-
Streptococcus pneumoniae favors tolerance via metabolic adaptation over resistance to circumvent fluoroquinolones.mBio. 2024 Feb 14;15(2):e0282823. doi: 10.1128/mbio.02828-23. Epub 2024 Jan 9. mBio. 2024. PMID: 38193698 Free PMC article.
-
Aetiological agents of adult community-acquired pneumonia in Japan: systematic review and meta-analysis of published data.BMJ Open Respir Res. 2023 Sep;10(1):e001800. doi: 10.1136/bmjresp-2023-001800. BMJ Open Respir Res. 2023. PMID: 37751988 Free PMC article.
-
Effects of Juhongtanke oral solution on alleviating the symptoms of community-acquired pneumonia: A multicenter, prospective, randomized controlled trial.Front Pharmacol. 2022 Oct 20;13:1027901. doi: 10.3389/fphar.2022.1027901. eCollection 2022. Front Pharmacol. 2022. PMID: 36339599 Free PMC article.
-
Multi-Modal Data Analysis for Pneumonia Status Prediction Using Deep Learning (MDA-PSP).Diagnostics (Basel). 2022 Jul 13;12(7):1706. doi: 10.3390/diagnostics12071706. Diagnostics (Basel). 2022. PMID: 35885612 Free PMC article.
-
Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial.JAMA Netw Open. 2021 Oct 1;4(10):e2129566. doi: 10.1001/jamanetworkopen.2021.29566. JAMA Netw Open. 2021. PMID: 34652445 Free PMC article. Clinical Trial.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical