Chest
ORIGINAL RESEARCHCOMMUNITY-ACQUIRED PNEUMONIAMisdiagnosis of Community-Acquired Pneumonia and Inappropriate Utilization of Antibiotics: Side Effects of the 4-h Antibiotic Administration Rule
Section snippets
Study Design
The study was performed in a 608-bed teaching hospital with 112,000 annual ED visits. We performed a retrospective study of all patients who were admitted to the ED with a diagnosis of CAP over two 6-month periods prior to the publication of IDSA guidelines2 (January to June 2003) and 1 year after publication (January to June 2005). We obtained an institutional review board approval prior to starting the study.
Patients
All patients ≥ 21 years of age who were admitted to the ED with a primary or
Patient Characteristics
A total of 734 patients (2003, 291 patients; 2005, 443 patients) were initially identified with an ED admitting diagnosis of pneumonia. Of these, 518 patients (2003, 199 patients; 2005, 319 patients) were included in our study. The reasons for study exclusion were age < 21 years (n = 118), incomplete data (n = 53), transfer from another acute care hospital (n = 27), or patients died, left the hospital against medical advice, or were given palliative care before a definite diagnosis was made (n
Discussion
The association between early antibiotic administration for CAP and improved outcomes has been reported in two large retrospective studies. Meehan et al3 found that the administration of antibiotics within 8 h of arrival at the hospital for Medicare patients was associated a lower 30-day mortality rate (odds ratio, 0.85; 95% confidence interval, 0.75 to 0.96). As a result, the Medicare National Pneumonia Project, from 1999 through 2002, promoted the administration of antimicrobial agents within
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This study received the Kass Award and was presented at the 44th Annual Meeting of the Infectious Diseases Society of America, October 2006.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.