SEATTLE — Of the recommended measures taken in hospital treatment of pneumonia, only the administration of the proper, empiric antibiotic appears to make any difference in patient mortality. Culturing blood does not. And prompt antibiotic treatment does not, according to a study from the Mayo Clinic presented at the annual research meeting of Academy Health.
To explore the actual impact of the three principles of care that are thought to have the most influence in pneumonia treatment, the Mayo Clinic researchers analyzed data from a random selection of patients admitted with a diagnosis of pneumonia to the clinic's Rochester, Minn., facility between July 2004 and June 2005, a total of 395 patients. They excluded those who received comfort care only, those transferred from other institutions, and those who did not receive antibiotic treatment within 36 hours.
Since some patients were treated with adherence to all three of those principles—and some only one, two, or none—the patients could be compared for outcome, said Monica VanSuch, of the clinic's division of health care policy and research, in a poster presentation.
The study found that when patients were not treated with the type of antibiotic that guidelines suggest for empiric treatment, they were more likely to have a longer hospital stay (relative risk 1.71) and a decreased chance of survival (relative risk 3.26). They also tended to be less likely to be readmitted after discharge, though that finding was not statistically significant.
Whether the patient received an antibiotic within 4 hours, or within 8 hours, of admission did not make a difference in any of the outcomes. Neither did blood culturing.
The finding that the promptness of antibiotic treatment did not impact outcome is surprising, and might reflect a bias of the study instead of truth, Ms. VanSuch said in an interview. Only a small group of the patients did not receive the proper, empiric antibiotic (35 of the 395 patients), and the importance of that proper antibiotic might be so great that it overwhelmed the influence of prompt treatment in the analysis.