Introduction
Methods
Overview
Patients
Inclusion criteria
Exclusion criteria
Study variables
Statistical methods and data interpretation
Results
Patient population
Characteristic | |
---|---|
Age, years, mean (SD) [median] | 64.5 (18.5) [68.0] |
≥65 years, n (%) | 1,150 (56.4) |
Female, n (%) | 843 (41.3) |
Ethnic origin, n (%) | |
White | 1,573 (77.1) |
Non-white | 51 (2.5) |
Unknown/missing | 51 (2.5) |
Not applicable* | 364 (17.9) |
Residential/health status, n (%) | |
Private house or apartment | 1,720 (84.4) |
Nursing home | 145 (7.1) |
Home care through healthcare agency | 32 (1.6) |
Previous admission to hospital with CAP (last 3 months) | 99 (4.9) |
Immunocompromised/immunosuppressed | 72 (3.5) |
Haemodialysis | 6 (0.3) |
Chemotherapy for active cancer | 30 (1.5) |
Other | 43 (2.1) |
Unknown | 85 (4.2) |
Smoking status, n (%) | |
Non-smoker | 704 (34.5) |
Ex-smoker | 553 (27.1) |
Occasional smoker | 42 (2.1) |
Habitual smoker | 463 (22.7) |
Unknown | 277 (13.6) |
Characteristic | |
---|---|
Relevant medical conditions at hospitalization (index visit) (≥5% of analysis population), n (%) | |
Any relevant condition | 1,598 (78.4) |
Respiratory disease | 689 (33.8) |
Diabetes | 369 (18.1) |
Congestive heart disease | 336 (16.5) |
Cancer/malignancy | 237 (11.6) |
Peripheral vascular disease | 183 (9.0) |
Renal disease | 147 (7.2) |
Other relevant conditions* | 684 (33.5) |
Medication history in the 3 months prior to hospitalization, n (%) | |
Any prior medication | 1,143 (56.1) |
Antibiotics/antivirals | 395 (19.4) |
Anticoagulants | 301 (14.8) |
Immunosuppressants/immunomodulators | 151 (7.4) |
NSAIDs | 137 (6.7) |
Any other relevant therapies* | 379 (18.6) |
Unknown | 146 (7.2) |
Patient hospitalized for any reason in the 3 months prior to index visit, n (%) | 204 (10.0) |
Invasive surgical treatment in the 3 months prior to index visit, n (%) | 33 (1.6) |
Time since previous date of hospitalization, days, mean (SD) [median] (n = 182) | 37.7 (24.0) [33.5] |
Time since symptom start date to hospitalization (index visit), days, mean (SD) [median] (n = 1,905) | 4.9 (9.1) [3.0] |
Time since date of hospitalization (index visit) to first diagnosis date, days, mean (SD) [median] (n = 1,948) | 0.5 (4.6) [0.0] |
Characteristic | |
---|---|
Type of CAP, n (%) | |
CAP* | 1,607 (78.8) |
HCAP† | 245 (12.0) |
Immunocompromised/immunosuppressed | 72 (3.5) |
Other | 43 (2.1) |
Unknown | 85 (4.2) |
Radiographic findings suggestive of bacterial pneumonia, n (%) | |
Infiltrate | 1,168 (57.3) |
Consolidation | 947 (46.4) |
Pleural effusion | 319 (15.6) |
Other | 100 (4.9) |
Unknown | 16 (0.8) |
Signs of acute illness at diagnosis, n (%) | |
New or increased cough | 1,575 (77.2) |
Purulent sputum or change in sputum character | 1,053 (51.6) |
Auscultatory findings consistent with pneumonia | 1,492 (73.2) |
Dyspnoea, tachypnoea, or hypoxaemia | 1,491 (73.1) |
Fever or hypothermia | 1,317 (64.6) |
White blood cell count >10,000 cells/mm3 or <4,500 cells/mm3 | 1,352 (66.3) |
Prognosis based on severity indices | |
PORT/PSI | |
Total, n (%) | 354 (17.4) |
Score, mean (SD) | 3.5 (1.1) |
I, n (%) | 18 (0.9) |
II, n (%) | 53 (2.6) |
III, n (%) | 83 (4.1) |
IV, n (%) | 148 (7.3) |
V, n (%) | 52 (2.6) |
CURB-65 | |
Number of patients (%) | 527 (25.8) |
Score, mean (SD) | 2.2 (1.1) |
Diagnostic information
Treatment setting and modalities
Clinical outcomes
Outcome | |
---|---|
Initial antibiotic treatment modification, n (%), for reasons:* | 589 (28.9) |
Insufficient response/treatment failure | 244 (12.0) |
Adverse events | 41 (2.0) |
Possible interaction with other treatment | 1 (<0.1) |
Other | 149 (7.3) |
Unknown | 47 (2.3) |
No reason reported | 107 (5.2) |
Death while on initial therapy | 63 (3.1) |
Streamlining (de-escalation) of therapy†, n (%) | 105 (5.1) |
Time to initial treatment modification, days, mean (SD) [median] (n = 760) | 5.0 (3.8) [4.0] |
Number of antibiotic therapy courses, n (%) | |
1 | 1,086 (53.3) |
2 | 644 (31.6) |
3 | 190 (9.3) |
>3 | 116 (5.7) |
Time to clinical stability, days, mean (SD) [median] (n = 1,603) | 5.6 (5.1) [4.0] |
Based on Halm criteria (n = 588) | 5.3 (5.4) [4.0] |
Based on switch from IV to oral therapy (n = 738) | 5.5 (4.1) [5.0] |
Based on other criteria (n = 278) | 6.4 (6.6) [5.0] |
Length of stay, days, mean (SD) [median] (n = 1,978)‡ | 12.6 (10.6) [10.0] |
Patients admitted to the ICU (n = 267)§ | 19.1 (17.1) [14.0] |
Patients not admitted to the ICU (n = 1,691)§ | 10.9 (7.5) [9.0] |
Discharged from hospital, n (%) | 1,836 (90.0) |
Reinfection/recurrence, n (%)¶ | 94 (4.6) |
Home-based care after discharge, n (%) | 73 (3.6) |
Duration of home-based care, days, mean (SD) [median] (n = 38) | 14.7 (15.0) [7.5] |
Mortality rate, n (%) | 147 (7.2) |
Outcome | Type of CAP | Recurrence | Comorbidities | Severity | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
PORT/PSI risk score | CURB-65 risk groups | ||||||||||||||
CAP only (n = 1,607) | HCAP (n = 245) | Immuno-compromised/immuno-suppressed (n = 72) | With (n = 94) | Without (n = 1,548) | With (n = 1,598) | Without (n = 441) | I (n = 18) | II (n = 53) | III (n = 83) | IV (n = 148) | V (n = 52) | Mild (0–1) (n = 154) | Moderate (2) (n = 185) | Severe (3–5) (n = 176) | |
Initial antibiotic treatment modification, n (%) | 456 (28.4) | 78 (31.8) | 29 (40.3) | 32 (34.0) | 409 (26.4) | 473 (29.6) | 116 (26.3) | 6 (33.3) | 15 (28.3) | 19 (22.9) | 42 (28.4) | 19 (36.5) | 37 (24.0) | 47 (25.4) | 55 (31.3) |
Streamlining, n (%) | 72 (4.5) | 21 (8.6) | 9 (12.5) | 8 (8.5) | 82 (5.3) | 84 (5.3) | 21 (4.8) | 0 | 4 (7.5) | 6 (7.2) | 6 (4.1) | 4 (7.7) | 4 (2.6) | 7 (3.8) | 6 (3.4) |
Reinfection/recurrence, n (%) | 70 (4.4) | 16 (6.5) | 5 (6.9) | 94 (100) | 0 | 88 (5.5) | 6 (1.4) | 0 | 2 (3.8) | 4 (4.8) | 9 (6.1) | 5 (9.6) | 2 (1.3) | 11 (5.9) | 12 (6.8) |
Length of stay, days, median | 9.0 (n = 1,558) | 10.0 (n = 235) | 12.0 (n = 71) | 11.0 (n = 94) | 9.0 (n = 1,548) | 10.0 (n = 1,555) | 8.0 (n = 423) | 8.0 (n = 18) | 8.0 (n = 53) | 10.0 (n = 80) | 10.0 (n = 148) | 13.0 (n = 51) | 8.0 (n = 153) | 9.5 (n = 180) | 10.0 (n = 175) |
Time to clinical stability, days, median | 4.0 (n = 1,284) | 4.0 (n = 182) | 5.0 (n = 55) | 5.0 (n = 78) | 4.0 (n = 1,295) | 4.0 (n = 1,258) | 4.0 (n = 345) | 3.5 (n = 18) | 3.0 (n = 43) | 4.0 (n = 63) | 5.0 (n = 139) | 7.0 (n = 40) | 4.0 (n = 137) | 5.0 (n = 156) | 5.0 (n = 142) |
Mortality rate, n (%) | 89 (5.5) | 40 (16.3) | 7 (9.7) | 1 (1.1) | 1 (0.1) | 128 (8.0) | 19 (4.3) | 0 | 1 (1.9) | 7 (8.4) | 6 (4.1) | 11 (21.2) | 6 (3.9) | 12 (6.5) | 29 (16.5) |