Emergency Department Patients with Community Acquired Pneumonia: Effect of a Change in Pneumonia Definition by Centers for Medicare and Medicaid Services on Compliance with Guidelines for Time to Antibiotic Administration

Abstract Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

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Faculty Opinions recommendation of Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4175956.3963054 ◽

2010 ◽

Author(s):

Richard Wunderink

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Community Acquired Pneumonia ◽

Emergency Department Patients

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The impact of ﬁrst Timing of antibiotics for community acquired pneumonia in emergency department

10.22514/sv.2020.16.0107 ◽

2020 ◽

Keyword(s):

Emergency Department ◽

Antibiotic Treatment ◽

Relevant Literature ◽

Severity Of Illness ◽

Clinical Situation ◽

Community Acquired Pneumonia ◽

Antibiotic Administration ◽

Eligibility Criteria ◽

Antibiotic Overuse ◽

The Impact

Background and objective: For patients with community-acquired pneumonia (CAP), reported associations between timing of the first dose of antibiotics and short-term mortality are inconsistent. To reduce the risks of antibiotic overuse in the emergency department, this summary of the relevant literature identified patients with CAP who benefit most from early antibiotic administration. Methods: A PubMed and Google Scholar search was performed for articles concerning the epidemiology, prognosis, diagnosis, and preliminary management of CAP. Results: Duplicate studies were eliminated and 370 citations were screened. Finally, 16 studies met the eligibility criteria. The review found that, in the presence of sepsis, antibiotics should not be delayed but administered as soon as possible. For patients with moderate-to-severe symptoms, antibiotics should be administered if a diagnosis of CAP is highly likely. For stable, non-critically ill patients with CAP, the timing of antibiotics remains unclear, but available evidence does not indicate strict requirements. For best quality of care, antibiotic timing whether rapid or delayed depends on the clinical situation. Conclusions: In suspected cases of pneumonia presenting in the emergency department, starting antibiotics early solely to conform to dogmatic guidelines within a rigid timeframe has led to unnecessary antibiotic treatment of uninfected patients, while the outcomes of patients with pneumonia have not improved. Since severity of illness is the key factor associated with poor outcomes in pneumonia, the timing of initial antibiotic treatment should be guided by the severity of symptoms.

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