Guideline-concordant therapy and outcomes in healthcare-associated pneumonia

Eur Respir J. 2011 Oct;38(4):878-87. doi: 10.1183/09031936.00141110. Epub 2011 Mar 24.


Healthcare-associated pneumonia (HCAP) guidelines were first proposed in 2005 but have not yet been validated. The objective of this study was to compare 30-day mortality in HCAP patients treated with either guideline-concordant (GC)-HCAP therapy or GC community-acquired pneumonia (CAP) therapy. We performed a population-based cohort study of >150 hospitals in the US Veterans Health Administration. Patients were included if they had one or more HCAP risk factors and received antibiotic therapy within 48 h of admission. Critically ill patients were excluded. Independent risk factors for 30-day mortality were determined in a generalised linear mixed-effect model, with admitting hospital as a random effect. Propensity scores for the probability of receiving GC-HCAP therapy were calculated and incorporated into a second logistic regression model. A total of 15,071 patients met study criteria and received GC-HCAP therapy (8.0%), GC-CAP therapy (75.7%) or non-GC therapy (16.3%). The strongest predictors of 30-day mortality were recent hospital admission (OR 2.49, 95% CI 2.12-2.94) and GC-HCAP therapy (OR 2.18, 95% CI 1.86-2.55). GC-HCAP therapy remained an independent risk factor for 30-day mortality (OR 2.12, 95% CI 1.82-2.48) in the propensity score analysis. In nonsevere HCAP patients, GC-HCAP therapy is not associated with improved survival compared with GC-CAP therapy.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Cohort Studies
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / mortality
  • Cross Infection / drug therapy*
  • Cross Infection / mortality*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hospital Mortality
  • Humans
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / mortality*
  • Practice Guidelines as Topic
  • Risk Factors
  • Survival Analysis
  • United States / epidemiology
  • United States Department of Veterans Affairs / statistics & numerical data


  • Anti-Bacterial Agents