The effect of taking antibacterial therapy on the outpatient stage and outcomes of community-acquired pneumonia in Tomsk hospitals

Abstract

Background. Community-acquired pneumonia (CAP) remains one of the most common diseases requiring urgent hospitalization, with a significant part of patients already receiving antibiotics before admission to the hospital.
 Aim. To assess the relationship between outpatient antibacterial therapy and in-hospital mortality and the severity of the CAP.
 Materials and methods. The retrospective study included the data of adult patients with CAP who were hospitalized in Tomsk from January 1 to December 31, 2017.
 Results. Among 1412 patients, 22.2% received antibiotics before admission to the hospital, the proportion of deaths in this group was significantly lower – 3.8% compared with 10.6% among patients without antibiotic therapy (p0.001). Subjects who received antibiotics on outpatient basis were less likely to require being in the intensive care unit and administering vasopressors, in contrast to patients without prior antibiotic therapy: 5.1 and 10.6% (p=0.003); 7.1 and 4.7% (p=0.018) respectively. In patients with severe CAP on a scale IDSA/ATS, only 11.8% of cases were detected with antibiotics before hospitalization, while in mild CAP the frequency of administration was 16.6% (p0.001).
 Conclusion. Ambulatory antibacterial therapy had a positive effect on the subsequent course and outcomes of CAP in a hospital setting. Patients had a predominantly mild course of the disease, needing for vasopressors, and being in the intensive care unit, but was not consistent with the need for invasive mechanical ventilation.