Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia

Genne, Daniel; Sommer, Richard Andréas; Kaiser, Laurent; Saaidia, Abdelkader; Pasche, A.; Unger, Pierre-François; Lew, Daniel Pablo

doi:10.1007/s10096-006-0113-3

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Title		Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia
Authors		Genne, Daniel Sommer, Richard Andréas Kaiser, Laurent Saaidia, Abdelkader Pasche, A. Unger, Pierre-François Lew, Daniel Pablo
Published in		European Journal of Clinical Microbiology & Infectious Diseases. 2006, vol. 25, no. 3, p. 159-166
Abstract		To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11-9.56), neurological disease (OR 2.34; 95%CI 1.07-5.13), and aspiration pneumonia (OR 2.97; 95%CI 29-6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20-0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis.
Keywords		Adolescent — Adult — Aged — Aged, 80 and over — Anti-Bacterial Agents/ therapeutic use — Community-Acquired Infections/ drug therapy/microbiology — Female — Hospitalization — Hospitals, University — Humans — Male — Middle Aged — Pneumonia, Bacterial/ drug therapy/microbiology — Risk Factors — Switzerland — Treatment Failure
Identifiers		DOI: 10.1007/s10096-006-0113-3 PMID: 16528540
Full text		Article - Limited access to UNIGE Other version: http://www.springerlink.com/content/7552152p105735t1/fulltext.pdf
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine
Research group		Groupe Laurent Kaiser (virologie clinique) (668)
Citation (ISO format)		GENNE, Daniel et al. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia. In: European Journal of Clinical Microbiology & Infectious Diseases, 2006, vol. 25, n° 3, p. 159-166. doi: 10.1007/s10096-006-0113-3 https://archive-ouverte.unige.ch/unige:7271