2222. Impact of Empiric Aminoglycoside Usage on Outcomes in Bacterial Pneumonia

Abstract Background Although aminoglycosides are recommended as part of empiric combination therapy in selected patients with healthcare-associated pneumonia, their efficacy and safety remains unclear. The objectives of this study were to evaluate the impact of empiric aminoglycoside treatment on microbiologic cure, recurrent pneumonia and death, and acute kidney injury (AKI) among hospitalized patients treated for pneumonia who were clinically cured. Methods This was a nested cohort study including 441 hospitalized subjects with confirmed bacterial pneumonia who achieved clinical cure. All subjects had positive respiratory cultures at the beginning of therapy and also had cultures obtained at the time of antibiotic completion. Subjects with the same pathogen present at both the beginning of and at the end of treatment were categorized as microbiologic failure and all others were categorized as microbiologic cure. Serum creatinine was measured at both the beginning and end of therapy, with an absolute increase in serum creatinine of 0.5 mg/L or greater defined as AKI. Composite outcomes of 30- and 90-day recurrent pneumonia or death following the clinical cure of the index pneumonia were captured. Patients who received empiric aminoglycoside therapy were compared with patients who did not receive aminoglycoside therapy. Results Of 441 included subjects, 14.5% (N = 64) received aminoglycoside therapy and 85.5% (N = 377) did not. The mean age was 54.7 years, with 70.5% male and 78.2% white. Characteristics of the two groups (including Charlson Comorbidity Indices and APACHE II scores) were similar. Rates of microbiologic cure, death/recurrent pneumonia at 30- and 90-days and AKI and were similar in both groups (table). In subgroup analyses restricted to different pathogen groups these associations remained unchanged. Conclusion Among hospitalized patients with pneumonia who were clinically cured, empiric aminoglycoside therapy was not associated with an increased likelihood of microbiologic cure, death or recurrent pneumonia or AKI. Disclosures All authors: No reported disclosures.

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Anemia as a risk factor of contrast-associated acute kidney injury

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.12.200450 ◽

2020 ◽

Vol 92 (12) ◽

pp. 48-52

Author(s):

O. Iu. Mironova ◽

A. D. Deev ◽

P. G. Lakotka ◽

V. V. Fomin

Keyword(s):

Coronary Artery Disease ◽

Acute Kidney Injury ◽

Risk Factor ◽

Coronary Artery ◽

Serum Creatinine ◽

Statistical Significance ◽

Kidney Injury ◽

Chronic Coronary Artery Disease ◽

Absolute Increase ◽

Artery Disease

Aim.The aim of our study was to assess the role of anemia as a risk factor of contrast-associated acute kidney injury (CA-AKI) in patients with stable coronary artery disease. Materials and methods.1023 patients with chronic coronary artery disease were enrolled in a prospective, open, cohort study (ClinicalTrials.gov ID NCT04014153). 83 patients had anemia. CA-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint of the study was the development of CA-AKI according to KDIGO criteria. Results.CA-AKI developed in 12 (14.5%) patients with anemia according to the relative increase of the level of serum creatinine (25% and more from the baseline). With using the absolute increase of the level of serum creatinine the prevalence of CA-AKI was 2 (2.4%) patients. Patients with anemia had higher rate of CA-AKI than the overall population of the study (14.4% versus 12.7%). Although our results were not statistically significant (р=0.61, odds ratio 1.19, 95% confidence interval 0.632.24). Conclusion.The prevalence of CA-AKI was higher in the group of patients with anemia, but didnt meet statistical significance and needs further evaluation in larger studies.

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Abstract T P29: The Impact of Contrast Based CTA/CTP Brain Attack Protocol on Kidney Function

Stroke ◽

10.1161/str.46.suppl_1.tp29 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Jamie Folsom ◽

Nnadozie Ezerioha ◽

Pratik Chhatbar ◽

Swaroop Pawar ◽

Christina Holmstedt ◽

...

Keyword(s):

Acute Stroke ◽

Creatinine Level ◽

Endovascular Therapy ◽

Kidney Injury ◽

Complete Information ◽

Absolute Increase ◽

Stroke Imaging ◽

Clinical Consequences ◽

Stage Renal Disease ◽

The Impact

Background: We aimed to evaluate the occurrence of acute kidney injury (AKI) associated with contrast based CTA/CTP Brain Attack (BAT) Protocol in a cohort of patients who presented to an academic stroke center with acute stroke symptoms. Methods: Consecutive patients who presented to the Emergency Department with acute stroke symptoms from 01/12 to 12/12 and received CTA/CTP contrast-based BAT protocol were identified and their medical records reviewed. Clinicodemographic information was retrieved. Serum creatinine values at baseline, at discharge, and at a follow-up visit, as well as the highest in-hospital value were recorded. AKI was defined as a 0.3 absolute increase in creatinine level from baseline. A logistic regression was fit to identify the potential predictors for AKI. Results: Of 348 patients had complete information. 37(11%) patients experienced AKI during hospitalization. Of 38 patients, 16 (43%) patients had persistent elevated creatinine at hospital discharge (5 patients also received endovascular therapy); 11(38%) patients returned to baseline, and the rest 10(26%) patients’ creatinine improved but did not return to baseline. No patient develops end stage renal disease requiring hemodialysis. Baseline creatinine level (p<0.002), comorbidity index (p=0.05) and endovascular therapy (p=0.01) were the three main predictors of AKI. Race, gender and age were not predictors of AKI. Conclusion: Contrast based CTA/CTP BAT protocol may incur a small risk of AKI in patients but clinical consequences are minimal. Risks seem greater in patients with higher presenting creatinine level, more comorbidities and those receiving additional contrast from endovascular therapy. More data are required to understand the clinical impact of contrast-based CT stroke imaging protocols.

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TO020POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI BY AUTOMATED DECISION SUPPORT ALGORITHMS: IMPACT ON AKI INCIDENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa141.to020 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jill Vanmassenhove ◽

Johan Steen ◽

Johan Decruyenaere ◽

Dominique Benoit ◽

Eric Adriaan J Hoste ◽

...

Keyword(s):

Big Data ◽

Decision Support ◽

Serum Creatinine ◽

Sofa Score ◽

Kidney Injury ◽

Baseline Serum ◽

Icu Admission ◽

And Gender ◽

Definition Of ◽

The Impact

Abstract Background and Aims The reported incidence of Acute Kidney Injury (AKI) at the intensive care unit (ICU) is variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of this definition, there is remaining variability in the actual implementation of this AKI definition, with variable interpretation of the urinary output (UO) criterion, and of the baseline serum creatinine (Screa) criterion. This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI or associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means and represents. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the incidence of AKI stage 2. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all available Screa data up to 1 year before ICU admission were retrieved from a dataset external to the ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we sued either a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we also applied two criteria in line with K-DIGO stage 2: a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Def 8 identified patients who did not comply with any of the definitions (1-7), so who had no AKI according to any definition. Definition 9 and 10 identified patients who complied with at least one out of the Screa criteria 1-5 (def 9) or out of the UO criteria (def 10). Definition 11 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset included 16433 ICU admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died at ICU, and another 5.2% during their hospitalisation. The SOFA score at admission was 6.9±4.1. The incidence of AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria from 4.3% when baseline creatinine was defined as the first ICU value, to 35.3% when the UO criterium was interpreted as a UO below 6ml/kg over a 12 hour block (fig). Only half of patients (53.7%) did not comply with any of the definitions (def 8), 10.9% and 19.7% complied with one of the Screa (def 9) OR one of the UO criteria (def 10) respectively, and 15.7% complied with both (def 11). There was substantial reclassification across the different definitions. Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in incidence of AKI, and also with substantial reclassification according to different definitions. This is especially concerning in an era of big data and automated decision support, as clinicians might not know which construct of AKI is actually being represented.

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P0566INCIDENCE AND IMPACT OF ACUTE KIDNEY INJURY (AKI) IN ANDALUSIA

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0566 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Wenceslao Aguilera Morales ◽

Alfonso Lara Ruiz ◽

Irene Díaz Díez ◽

Mercedes Salgueira Lazo

Keyword(s):

Acute Kidney Injury ◽

Hospital Admissions ◽

Kidney Injury ◽

Hospitalized Patients ◽

Cost Ratio ◽

Autonomous Community ◽

Cross Sectional ◽

Mortality Ratio ◽

The Impact ◽

Overall Mortality

Abstract Background and Aims Acute Kidney Injury (AKI) is an insufficiently reported clinical entity with significant impact on overall mortality, hospital stay and associated costs, increasing the risk of progression to Chronic Kidney Disease. It is especially relevant in hospitalized patients, where the incidence has doubled in the last decade, reaching 22-25%. Aims: Know the reported incidence of AKI in the Andalusian Autonomous Community, and its impact on mortality, average stay and associated costs. Method Cross-sectional descriptive study that analyzes data from all Andalusian hospitals, extracted from CMBDA corresponding to 2017. Hospitalization episodes, reference units, episodes with AKI at discharge, exitus and average stays were collected. An associated cost estimate analysis was also carried out using as reference the costs/day hospitalization in each SAS Assistance Unit according to BOJA Number 218 (14nov2016). The groups were compared according to the presence of the diagnosis of AKI. Results There were 525,757 hospital admissions in Andalusia; 25,727 reported the diagnosis of AKI at discharge, assuming an incidence of 4.89%. Patients with AKI total 316,938 stays, with an average stay of 15.5 + 13.8 days, compared to 6.5 + 6 days in which they have no associated diagnosis (p <0.01). The estimated costs associated with the diagnosis of AKI were 168,922,706 euros, with a cost / episode of 24,693 euros vs 3796 in the rest (p <0.01) (AKI/noAKI cost ratio: 6.5), and a cost / day / patient of 823 + 437 euros for AKI compared to 571 euros in the rest. The overall mortality associated with AKI was 26.8% (median 16.6%) vs. 4.76% (median 0.7%) in the rest (p <0.01). AKI/noAKI mortality ratio: 16. These data may be underestimated since the completion of the CMBDA is not complete in all hospitals and also the diagnosis of AKI may have been present and not reported upon discharge. Estimated costs did not include dialysis sessions. Conclusion The incidence of hospital AKI in our Autonomous Community is lower than that reported in the literature, probably due to inadequate reporting to CMBD. In spite of the limitations, our data show the impact of the diagnosis of AKI in hospitalized patients, multiplying by 2.5 the average stay, by 6.5 the associated costs and by 16 mortality, assuming a big problem Public Health that makes it imperative to develop measures to reduce the impact it entails.

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Concurrent Acute Kidney Injury with Vancomycin Use during the Engraftment Period in Patients Undergoing Autologous Stem Cell Transplant: A Single Institution Experience

Blood ◽

10.1182/blood.v128.22.2208.2208 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2208-2208

Author(s):

Adolfo E Diaz-Duque ◽

Juan J. Toro ◽

Francisca Cecilia Gushiken

Keyword(s):

Acute Kidney Injury ◽

Stem Cell ◽

Serum Creatinine ◽

Stem Cell Transplant ◽

Kidney Injury ◽

Autologous Stem Cell Transplant ◽

Cell Transplant ◽

Close Monitoring ◽

Absolute Increase ◽

Fluid Status

Background Infections are potential life-threatening complications during profound neutropenia in patients undergoing high dose chemotherapy with autologous stem cell transplant (HDC-ASCT). The current standard of practice is to start empiric broad spectrum antibiotics as soon as the patient becomes febrile. However, patients undergoing transplant also develop fever due to engraftment. Fever in this case is non-infectious and rather related to cytokine release from newly engrafted cells. Indeed, patients with engraftment syndrome experience signs of capillary leakage such as lung infiltrates, swelling, edema and generalized papule-macular erythema. Within this setting fever is always present. In our institution we made the observation that a significant number of patients develop acute kidney injury (AKI) when treated with vancomycin during the engraftment period. Perhaps renal hypo-perfusion due to fluid shifting during engraftment makes these patients more susceptible to drugs with a nephrotoxic profile, such as vancomycin. The objective of the current study was to identify the incidence, predictors and outcome for AKI in patients who received HDC-ASCT and were treated with Vancomycin during the engraftment period. Close monitoring of fluid status to maintain an adequate renal perfusion may prevent kidney injury during this time. Methods The study population consisted of patients who underwent HDC-ASCT from January 2011 to December 2013 at the Audie L. Murphy Memorial Veterans Hospital. Only patients who developed fever during the time of engraftment where included. Rising of baseline creatinine from the time of fever was compared between those who receive vancomycin and the group who did not. Both groups were comparable and matched for age, race and diagnosis. The development of acute kidney injury was defined according to a modified RIFLE criteria developed by the Acute Kidney Injury Network (AKIN). Differences among variables were evaluated by the Chi-square test and Mann-Whitney U test for categorical and continuous variables, respectively. Results Data from a total of 169 patients was collected. Only 119 developed fever, thus far 50 patients were excluded. Out of those 119 patients, 13 had fever outside the engraftment period, therefore a total of 106 patients were analyzed. From these, 50 (47.1%) received vancomycin and 56 (52.9%) did not. Eighteen patients (17%) out of the entire group had multiple myeloma and 88 (83%) lymphoma (Hodgkin and non-Hodgkin). Twenty seven (54%) patients who received vancomycin had an abrupt (within 48 hours) absolute increase in the serum creatinine concentration of ≥0.3 mg/dL from baseline compared to the control group (p<0.05). From the same group, 20 (40%) patients experienced ≥50 percent increase in the serum creatinine and 2 patients (4%) required dialysis. In comparison, only 5 (8.9%) of the patients in the not vancomycin group developed AKI (p<0.05). (See figure 1). Conclusion Acute kidney injury related to treatment with vancomycin in patients who develop fever at the time of engraftment is a frequent complication in the studied population. Judicious use of vancomycin with close monitoring of renal function and fluid status during engraftment period is warranted. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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The Revelations of Acute Kidney Injury in Cases of Acute Febrile Illness – A Hospital Based Observational Study from North Eastern India

Advancements in Journal of Urology and Nephrology ◽

10.33140/ajun.02.01.04 ◽

2020 ◽

Vol 2 (1) ◽

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Urine Volume ◽

Kidney Injury ◽

Febrile Illness ◽

Hospitalized Patients ◽

Acute Febrile Illness ◽

Medical College ◽

Definition Of ◽

Unexpected Outcome

Background: Clinicians across the globe refer to the published KDIGO definition of Acute Kidney Injury (AKI) as one of the following: • An increase in serum creatinine by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hrs • An increase in serum creatinine to ≥1.5 times baseline within the previous 7 days • Urine volume <0.5 ml/kg/h for 6 hrs Acute febrile illnesses are a common cause of AKI in hospitalized patients. The present study was undertaken to evaluate the incidence of AKI in patients presenting with acute febrile illness and also study the different etiological factors responsible for acute febrile illness. Materials and Methods: The study included 200 patients of acute febrile illness admitted in Silchar Medical College And Hospital in the Department of Medicine over a period of 24 months. The data regarding the various causes such as the etiology of fever, kidney function tests and other parameters of the cases were obtained and analyzed using simple statistical methods. Results and Observations: A total of 52 patients (26%) with acute febrile illness due to etiologies like Leptospirosis, Falciparum Malaria, Enteric fever, Dengue, Scrub Typhus, and mixed Malaria, etc developed AKI out of the 200 admitted cases presenting with acute febrile illness. Conclusion: The incidence of AKI is common in hospitalized patients of acute febrile illness and a thorough evaluation and detailed clinicobiochemical monitoring of the patients are necessary as it has varied etiology and often lead to an unfavorable or even unexpected outcome.

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MO364ASSOCIATION OF AKI-EVENT DEFINED BY DIFFERENT DEFINITIONS WITH IN-HOSPITAL MORTALITY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0018 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Fateme Nateghi ◽

Konstantinos Makris ◽

Pierre Delanaye ◽

Hans Pottel

Keyword(s):

Logistic Regression ◽

Hospital Mortality ◽

Hospital Admissions ◽

Kidney Injury ◽

Relative Increase ◽

Local Health ◽

Absolute Increase ◽

Severe Stage ◽

Stage 1 ◽

The Impact

Abstract Background and Aims Studies have shown that millions of hospitalized patients suffer from Acute Kidney Injury (AKI) per year which increases mortality risk for these patients. Different definitions for AKI have been proposed during the past years such as RIFLE (2002) and AKIN (2004). In 2012, KDIGO published a clinical practice guideline harmonizing AKIN and RIFLE into one general guideline which classifies AKI into 3 stages, where stage 1 is defined as an absolute increase of SCr ≥ 0.3 mg/dl over 48 hours or a relative increase in SCr ≥ 50% from baseline within the previous 7 days. A recent study [Sparrow et al., 2019] evaluated the impact of further categorizing AKI stage 1 into 2 stages based on SCr criteria. The study separates KDIGO AKI stage 1 and AKIN stage 1 into 2 stages (KDIGO-4 and AKIN-4) based on the different SCr criteria. Having different AKI deﬁnitions makes it challenging to analyze AKI incidence and associated outcomes among studies. The present study aimed to investigate the incidence of AKI events defined by 4 different definitions (standard AKIN and KDIGO, and modified AKIN-4 and KDIGO-4) and its association with in-hospital mortality. Method Retrospective clinical data available for all adult (≥18 years old) hospital admissions to a local health district in Athens, Greece between October 1999 and March 2019 was used in the analysis. We excluded patients whose time between admission and discharge was less than 7 days. Also, patients with less than 5 Scr measurements were omitted from the analysis resulting in the final cohort of 7242 admissions. We used the AKIN, KDIGO, AKIN-4, and KDIGO-4 definitions to check the incidence of AKI. As our second goal, we assessed associations of AKI-events with in-hospital mortality, adjusted for characteristics (age, sex, AKI staging) using multivariable logistic regression. Results The incidence of in-hospital AKI using the modified KDIGO-4 was 6.72% for stage 1a, 15.71% for stage 1b, 8.06% for stage 2, and 2.97% for stage 3; however, these percentages for AKIN-4 were 11.5%, 5.83%,1.75%, and 0.33% for stage 1a, stage 1b, stage 2, and stage 3, respectively. Using the standard KDIGO and AKIN definition, 19.08 and 14.05 % developed stage 1, respectively. To find the association between AKI stages and in-hospital mortality, we considered the most severe stage of AKI reached by a patient. Results of logistic regression models show that in-hospital mortality increased as the stage of AKI events increased for both KDIGO-4 and AKIN-4 (Table 1). Table 2 shows the same results using the original KDIGO and AKIN definitions. Conclusion The results of both definitions (AKIN-4 and KDIGO-4) show a significant association with mortality, but KDIGO-4 has a larger odds ratio meaning that AKI classification based on KDIGO-4 has a stronger association with mortality than AKI classification based on AKIN-4. However, based on our results, splitting stage 1 to stage 1a and stage 1b does not seem to make a difference; hence, using KDIGO-4 as a replacement for KDIGO would not have a significant impact on capturing AKI events.

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The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

Bone & Joint Open ◽

10.1302/2633-1462.111.bjo-2020-0141.r1 ◽

2020 ◽

Vol 1 (11) ◽

pp. 669-675

Author(s):

Alex E. Ward ◽

Daniel Tadross ◽

Fiona Wells ◽

Lawrence Majkowski ◽

Umna Naveed ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Bacterial Pneumonia ◽

Femur Fracture ◽

Kidney Injury ◽

High Rate ◽

Neck Of Femur ◽

Increased Risk ◽

Neck Of Femur Fracture ◽

The Impact

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

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Clinical Implications of Microbiologic Treatment Failure in the Setting of Clinical Cure of Bacterial Pneumonia

Clinical Infectious Diseases ◽

10.1093/cid/ciz1187 ◽

2019 ◽

Cited By ~ 1

Author(s):

Owen R Albin ◽

Oryan Henig ◽

Twisha S Patel ◽

Thomas S Valley ◽

Jason M Pogue ◽

...

Keyword(s):

Treatment Failure ◽

Clinical Cure ◽

Bacterial Pneumonia ◽

Acute Illness ◽

Therapeutic Interventions ◽

Comorbid Conditions ◽

Recurrent Pneumonia ◽

Ventilator Dependence ◽

Immunocompromised Status ◽

Cure Rates

Abstract Background Microbiologic cure is a common outcome in pneumonia clinical trials, but its clinical significance is incompletely understood. Methods We conducted a retrospective cohort study of adult patients hospitalized with bacterial pneumonia who achieved clinical cure. Rates of recurrent pneumonia and death were compared between patients with persistent growth of the index pathogen at the time of clinical cure (microbiologic failure) and those with pathogen eradication (microbiologic cure). Results Among 441 patients, 237 experienced microbiologic cure and 204 experienced microbiologic failure. Prevalences of comorbidities, ventilator dependence, and severity of acute illness were similar between groups. Patients with microbiologic failure experienced significantly higher rates of recurrent pneumonia or death following clinical cure than patients with microbiologic cure, controlling for comorbid conditions, severity of acute illness, appropriateness of empiric antibiotics, intensive care unit placement, tracheostomy dependence, and immunocompromised status (90-day multivariable adjusted odds ratio [OR], 1.56; 95% confidence interval [CI], 1.04–2.35). This association was observed among patients with pneumonias caused by Staphylococcus aureus (90-day multivariable adjusted OR, 3.69; 95% CI, 1.73–7.90). A trend was observed among pneumonias caused by nonfermenting gram-negative bacilli, but not Enterobacteriaceae or other pathogens. Conclusions Microbiologic treatment failure was independently associated with recurrent pneumonia or death among patients with bacterial pneumonia following clinical cure. Microbiologic cure merits further study as a metric to guide therapeutic interventions for patients with bacterial pneumonia.

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