Factors associated with early treatment failure in adult hospitalized patients with community-acquired pneumonia
2017
Background/Aim. Early treatment failure (ETF) in patients hospitalized for
community-acquired pneumonia (CAP) is associated with prolonged
hospitalization, increased risk of mortality and high treatment costs. The
aim of this study was to analyze relative importance of factors influencing
ETF in hospitalized adult patients with CAP that are still insufficiently
explored. Methods. A retrospective case-control study was carried out on a
sample of 126 adult patients treated for serious CAP at the Clinic for
Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia, during the
5-year period (2007-2011.). The cases (n=63) were consecutive patients with
ETF, observed within the three days upon the admission to hospital, while the
control group consisted of the equal number of randomly selected patients
without such an outcome. The association between potential risk/protective
factors and ETF was estimated using logistic regression analysis. Results.
The coexistence of gastrointestinal disorders (adjusted OR 18.83, 95%CI
1.15-309.04), higher CURB-65 score on admission (adjusted OR 2.57, 95%CI
1.05-6.25), initial use of nonsteroidal anti-inflammatory drugs (NSAIDs) in
hospital (adjusted OR 38.19, 95%CI 3.61-404.51) and previous outpatient use
of inhaled corticosteroids(adjusted OR 22.41, 95%CI 1.03-489.06) were found
to be significant risk factors for ETF. On the other hand, older age and use
of antibiotics before the hospitalization were associated with a
significantly lower chance of experiencing ETF, reducing the odds for 98% and
almost 90%, respectively. Conclusions. The avoidance of routine in-hospital
use of NSAIDs as well as outpatient use of appropriate antibiotics may be
beneficial for patients hospitalized for CAP in terms of reducing risk of
ETF. The CURB-65 score could be better predictor of ETF than Pneumonia
Severity Index. Further prospective studies are required to confirm these
findings.
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