Uncomplicated Community-acquired Pneumonia Research Articles

1870. Excess Antibiotic Duration in Patients Hospitalized for Pneumonia: A Multi-Hospital Cohort Study

Vaughn VM, Flanders SA, Chopra V, Conlon A, Malani A, Thyagarajan R, Hsaiky L and Gandhi TBackgroundDespite guidelines recommending patients with pneumonia receive the shortest effective duration of antibiotic therapy, patients continue to receive antibiotics for longer than necessary. Patterns and predictors of excess antibiotic duration are not well understood.MethodsCohort study of patients hospitalized with community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) between November 2015 and January 2018 at 48 hospitals participating in the Michigan Hospital Medicine Safety consortium. Adult, non-ICU, medical patients were included. Patients with concomitant infections, severe immunosuppression, or unusual pathogens were excluded. Detailed patient data, included duration of antibiotic treatment, were abstracted from the medical record. Appropriate duration was calculated for each patient based on time to clinical stability, organism, and comorbidities. Patient outcomes included mortality, readmission, length of stay, transfer to intensive care, and Clostridium difficile infection. Disease-, patient-, provider-, and hospital-factors associated with excess antibiotic duration and association of excess duration with patient outcomes were evaluated using multivariable generalized estimating equations models.ResultsA total of 3,776 patients were included in the final analysis (2,706 with CAP; 1,070 with HCAP). 69% (2,586/3,776) of patients received excess antibiotic duration (Figure 1). Antibiotics prescribed at hospital discharge accounted for 52% of total and 94% of excess antibiotic days. Factors associated with excess duration included: identification of bacterial pathogen (OR 1.9, 95% CI: 1.3, 2.8), more signs of pneumonia (OR 1.2, 95% CI: 1.1, 1.3 per sign), and uncomplicated CAP (OR 2.7 vs. HCAP). Comorbid heart failure was protective (OR 0.8, 95% CI: 0.6, 0.9). Hospitals varied widely with even the top performing hospital over-treating half of patients (Figure 2). There were no differences in any outcome for patients receiving excess vs. appropriate antibiotic duration. ConclusionMost hospitalized patients with pneumonia receive an excess antibiotic duration. CAP and antibiotics prescribed at discharge are major sources of excess use and thus key targets for stewardship.Disclosures All authors: No reported disclosures.

519. Longer Length of Antibiotic Therapy for Community-Acquired Pneumonia and Risk of Clostridium difficile Infection

BackgroundWe previously observed a median 9.5 days length of antibiotic therapy (LOT) among patients with community-acquired pneumonia (CAP) requiring hospitalization (Clin Infect Dis. 2018;66:1333–41). Treatment guidelines for CAP, however, suggest LOT >7 days is rarely necessary. In this study, we evaluated the risk of Clostridium difficile infection (CDI) as a potential harm of longer LOT.MethodsThis retrospective cohort study included Medicare beneficiaries with parts A, B, and D coverage hospitalized for uncomplicated CAP in 2012–2013 for 2–10 days, home discharge, and no hospitalizations 30 days before or 3 days after index hospitalization. The main exposure was total LOT, represented by the sum of estimated inpatient and observed outpatient LOT, and defined as “longer” if >9.5 days and “shorter” if ≤9.5 days. The outcome, post-discharge CDI, was defined using ICD-9-CM diagnosis code 008.45 in inpatient, skilled nursing, or outpatient claims within 6 months after index hospitalization. CDI 12 months before or during index hospitalization was excluded. CDI risk was assessed through a multivariable logistic model stratified by outpatient antibiotic class and adjusted for confounders including comorbidities, severity via ICU status, demographics, and hospital characteristics.ResultsThe cohort consisted of 99,883 patients. Median total LOT was 9.5 days (IQR: 7.4–11.4). Antibiotics filled at discharge included quinolones (40%), none (20%), multiple (14%), cephalosporins (10%), macrolides (7%), and β-lactam/β-lactamase inhibitor combinations (5%). CDI risk was 1.2%. Overall adjusted risk among those with longer LOT was 1.2 (95% CI: 1.1–1.4) times that of those with shorter LOT. Increased risk was observed among those prescribed quinolones at discharge, for whom adjusted CDI risk for longer LOT was 1.4 (95% CI: 1.2–1.7) times the risk of those with shorter LOT. We observed no difference in risk between longer and shorter LOTs for other antibiotic categories.ConclusionThese findings suggest that decreased LOT, which can be achieved with better adherence to current treatment guidelines, could reduce risk of subsequent CDI among patients hospitalized with CAP, particularly among those treated with fluoroquinolones at discharge.Disclosures All authors: No reported disclosures.

Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia.

National guidelines for pediatric community-acquired pneumonia (CAP) contain recommendations regarding diagnostic testing including chest radiographs (CXRs), complete blood counts (CBCs), and blood cultures. Local data indicated that our institution was not delivering care at standards outlined by these guidelines. This project aimed to decrease CXRs for children with CAP discharged from the emergency department (ED) by 10% and decrease CBCs and blood cultures for patients hospitalized with uncomplicated CAP by 20% within 1 year. This single-site quality improvement initiative targeted otherwise healthy children 3 months to 18 years who presented to the ED with uncomplicated CAP at a free-standing academic children's hospital. A quality improvement team performed a series of interventions including guideline implementation, data sharing, and annual education. Process measures included CXR, CBC, and blood culture rates. Balancing measures included the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and ED and hospital return rates. The team used statistical process control charts to plot measures. There was special cause improvement with a desirable downward shift in testing that correlated with the project's interventions. The percentage of CXRs for discharged patients decreased from 79% to 57%. CBCs and blood cultures for hospitalized patients decreased from 30% to 19% and 24% to 14%, respectively. Balancing measures remained unchanged. We used elements of quality improvement methodology to reduce testing for uncomplicated CAP without impacting the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and reutilization rates.

Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia.

To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21). CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.

Indicative role of membranolysis markers in the prognosis of uncomplicated community-acquired pneumonia in children of school age

Aim. To evaluate the indicative role of membranolysis markers in the prognosis of uncomplicated community-acquired pneumonia in school children and to establish its relation with zinc status indices.&#x0D; Methods. The study included 229 children aged 7 to 17 years with community-acquired pneumonia. The patients were divided into three groups based on morphological form of lung involvement: focal (103 children - group 1), segmental (64 patients - group 2), and lobar pneumonia (62 subjects - group 3). The state of cell membranes was evaluated by the activity of 5’-nucleotidase and rate of sodium-lithium countertransport in erythrocyte membrane. Intensity of peroxidation processes was evaluated by the level of end toxic products and total antioxidative activity, and additionally the blood concentration of zinc was measured by atomic absorption spectrophotometry.&#x0D; Results. Significant effect of membranolysis processes on the clinical course of pneumonia was revealed. The most prominent pathological changes of the studied indices were registered in patients with focal form of the disease (group 1): increase of the concentration of lipid peroxidation products in average to 5.4±0.06 umol/L and the level of 5’-nucleotidase to 233.90±9.15 nkat, decrease of serum level of zinc to 9.73±0.09 mmol/L and total antioxidative activity to 23.22±0.29%. It was associated with prolonged course and tendency to slow reversal of physical findings in the lungs compared to patients from groups 2 and 3 (p 0.05, respectively).&#x0D; Conclusion. Damage of cytoplasmic membrane in the focus of inflammation can be an objective marker of the course of community-acquired pneumonia in children and a sensitive prognostic sign and can allow identifying children into groups of high risk of prolonged course.

Antibiotic Prescribing Patterns Across the Continuum of Care for Children Hospitalized With Community-Acquired Pneumonia.

The aim of this study was to describe the variation in antibiotic prescribing practices for uncomplicated community-acquired pneumonia across the continuum of care for hospitalized pediatric patients to better inform future efforts at standardizing antibiotic therapy throughout a single hospitalization. This is a retrospective cohort study involving 4 hospitals caring for children aged 3 months to 18 years, hospitalized between January 1, 2011, and December 31, 2012, with diagnosis of uncomplicated pneumonia and without complex chronic medical conditions.Data collected include antibiotics prescribed before hospitalization, at the emergency department (ED) encounter, during hospitalization, and at hospital discharge. Six hundred nine children met inclusion criteria, with a mean age of 5.3 years and median length of stay of 2 days. Emergency department providers prescribed narrow-spectrum therapy 27% of the time, whereas discharging providers prescribed narrow-spectrum therapy 56% of the time. Third- and fourth-generation cephalosporins were less often prescribed in the preadmission setting and at discharge but were more often prescribed in the ED and inpatient setting. There was an association between inpatient prescription of broad-spectrum antibiotics when a blood culture was obtained, when broad-spectrum antibiotics were prescribed in the ED, and with increasing length of stay. Broad-spectrum antibiotic therapy for community-acquired pneumonia, especially third- and fourth-generation cephalosporins, often originates in the ED. When initiated in this setting, it is likely to be continued in the inpatient setting.

Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States.

Previous studies suggest that duration of antibiotic therapy for community-acquired pneumonia (CAP) often exceeds national recommendations and might represent an important opportunity to improve antibiotic stewardship nationally. Our objective was to determine the average length of antibiotic therapy (LOT) for patients treated for uncomplicated CAP in US hospitals and the proportion of patients with excessive durations. Records of retrospective cohorts of patients aged 18-64 years with private insurance and aged ≥65 years with Medicare hospitalized for CAP in 2012-2013 were used. Inpatient LOT was estimated as a function of length of stay. Outpatient LOT was based on prescriptions filled post discharge based on data from outpatient pharmacy files. Excessive duration was defined as outpatient LOT >3 days. Inclusion criteria were met for 22128 patients aged 18-64 years across 2100 hospitals and 130746 patients aged ≥65 years across 3227 hospitals. Median total LOT was 9.5 days. LOT exceeded recommended duration for 74% of patients aged 18-64 years and 71% of patients aged ≥65 years. Patients aged 18-64 years had a median (quartile 1-quartile 3) 6 (3-7) days outpatient LOT and those aged ≥65 years had 5 (3-7) days. In this nationwide sample of patients hospitalized for CAP, median total LOT was just under 10 days, with more than 70% of patients having likely excessive treatment duration. Better adherence to recommended CAP therapy duration by improving prescribing at hospital discharge may be an important target for antibiotic stewardship programs.

THE DASH PROJECT ‐ AN INTERVENTION AIMED AT CHANGING PHYSICIANS’ PRACTICE OF INPATIENT OBSERVATION FOLLOWING ANTIBIOTIC DE‐ESCALATION IN UNCOMPLICATED COMMUNITY ACQUIRED PNEUMONIA

RespirologyVolume 22, Issue S3 p. 226-226 APSR Poster Abstracts THE DASH PROJECT - AN INTERVENTION AIMED AT CHANGING PHYSICIANS’ PRACTICE OF INPATIENT OBSERVATION FOLLOWING ANTIBIOTIC DE-ESCALATION IN UNCOMPLICATED COMMUNITY ACQUIRED PNEUMONIA First published: 23 November 2017 https://doi.org/10.1111/resp.13207_362Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, IssueS3Supplement: 22nd Congress of the Asian Pacific Society of Respirology, International Convention Centre, Sydney, Australia, 23–26 November 2017November 2017Pages 226-226 RelatedInformation

Evaluation of Management of Uncomplicated Community-Acquired Pneumonia

Background Community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality in the United States. Studies have shown that interventions such as shorter antibiotic therapy and early intravenous (IV) to oral conversion can be safely performed. We evaluated areas of improvement at our institutions that could help optimize patient management while reducing collateral damage associated with excessive antibiotic usage. Methods In this retrospective analysis, all patients aged 18 years and older with a primary International Classification of Diseases, Ninth Revision code for CAP admitted from March 1, 2014, to October 31, 2014, were analyzed. The primary outcome was duration of antibiotic therapy for uncomplicated CAP (appropriate treatment duration defined as 7 days or less). Secondary objectives included duration of IV antibiotic therapy, duration of inpatient length of stay, and 30-day readmission rate related to CAP. Results Of the 141 patients evaluated, 98 (69.5%) met inclusion criteria. The mean total duration of antibiotic therapy was 10.1 ± 3.4 days, and the mean duration of IV therapy was 4.9 ± 3.3 days. Only 26.5% of patients received 7 days or less of antibiotic therapy, whereas 38.8% received greater than 10 days of therapy. Conclusions Our findings are concerning given the available data demonstrating that short-course therapy with 5 to 7 days is clinically as effective as long-course therapy and associated with fewer adverse events. The management of uncomplicated CAP represents a significant opportunity for antimicrobial stewardship intervention.

COMMUNITY AQUIRED PNEUMONIA IN ADULTS: POSSIBILITIES OF TREATMENT IN OUTPATIENT CONDITIONS

Community-acquired pneumonia (CAP) is a common and poorly diagnosed disease in the outpatient setting. The decision on hospitalization of the patient or treating him at home is the most important clinical conclusion made by the doctor in the course of the disease. Patients with non-severe course of CAP with the medical point of view are treated on an outpatient basis. Assessment of the severity of the patient CAP is based on the predictive Confusion-Respiratory rate – Blood pressure (CRB)-65 and criteria of systemic inflammatory response syndrome (SVR). CAP patients with a scale CRB 65 score 1 or more and/or syndrome SVR are hospitalized on an emergency basis. In accordance with the national guidelines for VAP amoxicillin is used to treat uncomplicated CAP as monotherapy (Group 1 included CAP patients). Amoxicillin is stable in an acidic environment and food intake doesn’t affect the drug absorption. Amoxicillin binds to plasma proteins by about 20% and easily permeates through histohematic barriers. The drug is active against aerobic gram-positive respiratory Staphylococcus spp. (except those strains producing penicillinase), Streptococcus pneumoniae and aerobic gram-negative respiratory organisms (Haemophilus influenzae, Escherichia coli, some strains of Klebsiella).

EMERGENCY DEPARTMENT RE-ATTENDANCES AND TREATMENT MODIFICATIONS IN YOUNG CHILDREN WITH UNCOMPLICATED COMMUNITY-ACQUIRED PNEUMONIA: A PERUKI STUDY

Objectives & BackgroundData on the rate of antibiotic retreatment in children with uncomplicated community-acquired pneumonia (CAP) are lacking. We conducted a service evaluation of CAP management to review assumptions for...

Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation

Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia. Retrospective medication utilization evaluation. Thirty Veterans Affairs medical centers. Inpatients discharged with a diagnosis of pneumonia. A manual review of electronic medical records of inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was conducted. Appropriate CAP therapy duration was defined as at least 5 days, and up to 3 additional days beginning the first day the patient achieved clinical stability criteria; the appropriate HCAP therapy duration was defined as 8 days. The duration of antimicrobial therapy for intravenous (IV) and oral (PO) inpatient administration, PO therapy dispensed upon discharge, Clostridium difficile infection (CDI), hospital readmission, and death rates were measured. Of 3881 pneumonia admissions, 1739 met inclusion criteria (CAP [n = 1195]; HCAP [n = 544]). Overall, 13.9% of patients (CAP [6.9%], HCAP [29.0%]) received therapy duration consistent with guideline recommendations. The median (interquartile range) days of therapy were 4 days (3-6 days), 1 day (0-3 days), and 6 days (4-8 days) for inpatient IV, inpatient PO, and outpatient PO antimicrobials, respectively. CDI was rare but more common in patients who received therapy duration consistent with guidelines. Therapy duration was not associated with the readmission or mortality rate. Antimicrobials were commonly prescribed for a longer duration than guidelines recommend. The majority of excessive therapy was completed upon discharge, identifying the need for strategies to curtail unnecessary use postdischarge. Journal of Hospital Medicine 2015;11:832-839. © 2015 Society of Hospital Medicine.

Hospitalization for Community-Acquired Pneumonia in Children: Effect of an Asthma Codiagnosis.

Community-acquired pneumonia (CAP) is a common and expensive cause of hospitalization among US children, many of whom receive a codiagnosis of acute asthma. The objective of this study was to describe demographic characteristics, cost, length of stay (LOS), and adherence to clinical guidelines among these groups and to compare health care utilization and guideline adherence between them. This was a multicenter retrospective cohort study using data from the Pediatric Health Information System. Children aged 2 to 18 who were hospitalized with uncomplicated CAP from July 1, 2007, to June 30, 2012 were included. Demographics, LOS, total standardized cost, and clinical guideline adherence were compared between patients with CAP only and CAP plus acute asthma. Among the 25,124 admissions, 57% were diagnosed with CAP only; 43% had a codiagnosis of acute asthma. The geometric mean for standardized cost was $4830; for LOS, it was 2.01 days. Eighty-four percent of patients had chest radiographs; CAP+acute asthma patients were less likely to have a blood culture performed (36% vs 62%, respectively) and more likely not to have a complete blood count performed (49% vs 27%, respectively). Greater guideline adherence was associated with higher cost at the patient-level but lower average cost per hospitalization at the hospital level. CAP+acute asthma patients had higher relative costs (11.8%) and LOS (5.6%) within hospitals and had more cost variation across hospitals, compared with patients with CAP only. A codiagnosis of acute asthma is common for children with CAP. This could be from misdiagnosis or co-occurrence. Diagnostic and/or management variability appears to be greater in patients with CAP+asthma, which may increase resource utilization and LOS for these patients.

When practice and policy conflict: blood cultures in community-acquired pneumonia

Optimal evidence-based management of patients with uncomplicated community-acquired pneumonia in the emergency department (ED) setting remains a topic of discussion. This discussion was recently revitalized by a 2014 study published in JAMA Internal Medicine by Makam et al showing an increase in the use of blood cultures for patients with community-acquired pneumonia during ED visits from 29.4% of patients in 2002 to 51.1% in 2010. As the authors acknowledge, one of the most likely explanations could be the former pneumonia core measures required by the Centers for Medicaid & Medicare Services and the Joint Commission, potentially encouraging both ED and inpatient providers to reflexively order cultures. As these measures were the subject of fierce debate in the emergency medicine literature almost a decade ago, with recent policy changes affecting practicing clinicians, we aimed to briefly revisit the developments and concerning guidelines and discuss some important potentials for research in this setting.

Does a child with pneumonia on a chest x-ray need a follow-up film to document clearance?

Evidence-Based Answer Repeat or follow-up chest x-ray (CXR) is not recommended in healthy children who recover uneventfully from an episode of uncomplicated community-acquired pneumonia (CAP) (SOR: B, prospective and retrospective trials).

Variability in care for children hospitalized for pneumonia: no excuses this time

Variability in care for children hospitalized for pneumonia: no excuses this time

Variation in Resource Utilization for the Management of Uncomplicated Community-Acquired Pneumonia across Community and Children's Hospitals

To describe patterns of diagnostic testing and antibiotic management of uncomplicated pneumonia in general community hospitals and children's hospitals within hospitals and to determine the association between diagnostic testing and length of hospital stay. We conducted a retrospective cohort study of children 1-17 years of age hospitalized with the diagnosis of pneumonia from 2007 to 2010 to hospitals contributing data to Perspective Database Warehouse, assessing patterns of diagnostic testing and antibiotic management. We constructed logistic regression models of log-transformed length of stay (LOS) and grouped treatment models to ascertain whether performance of blood cultures and viral respiratory testing were associated with LOS. A total of 17 299 pneumonia cases occurred at 125 hospitals, with considerable variability in pneumonia management. Only 40 (0.2%) received ampicillin/penicillin G alone or in combination with other antibiotics, and 1318 (7.4%) received macrolide monotherapy as initial antibiotic management. Performance of blood culture and testing for respiratory viruses was associated with a statistically significant longer LOS, but these differences did not persist in grouped treatment models. We observed greater rates of diagnostic testing in this cohort of structurally diverse hospitals than previously reported at freestanding children's hospitals, with extremely low rates of narrow-spectrum antibiotic use. Tailored antibiotic stewardship initiatives at these hospitals are needed to achieve adherence to national guideline recommendations.

Comparative Effectiveness of Empiric Antibiotics for Community-Acquired Pneumonia

Narrow-spectrum antibiotics are recommended as the first-line agent for children hospitalized with community-acquired pneumonia (CAP). There is little scientific evidence to support that this consensus-based recommendation is as effective as the more commonly used broad-spectrum antibiotics. The objective was to compare the effectiveness of empiric treatment with narrow-spectrum therapy versus broad-spectrum therapy for children hospitalized with uncomplicated CAP. This multicenter retrospective cohort study using medical records included children aged 2 months to 18 years at 4 children's hospitals in 2010 with a discharge diagnosis of CAP. Patients receiving either narrow-spectrum or broad-spectrum therapy in the first 2 days of hospitalization were eligible. Patients were matched by using propensity scores that determined each patient's likelihood of receiving empiric narrow or broad coverage. A multivariate logistic regression analysis evaluated the relationship between antibiotic and hospital length of stay (LOS), 7-day readmission, standardized daily costs, duration of fever, and duration of supplemental oxygen. Among 492 patients, 52% were empirically treated with a narrow-spectrum agent and 48% with a broad-spectrum agent. In the adjusted analysis, the narrow-spectrum group had a 10-hour shorter LOS (P = .04). There was no significant difference in duration of oxygen, duration of fever, or readmission. When modeled for LOS, there was no difference in average daily standardized cost (P = .62) or average daily standardized pharmacy cost (P = .26). Compared with broad-spectrum agents, narrow-spectrum antibiotic coverage is associated with similar outcomes. Our findings support national consensus recommendations for the use of narrow-spectrum antibiotics in children hospitalized with CAP.

The Power of Quality Improvement to Improve Antibiotic Prescribing in Hospitalized Children

In 2011, the first U.S. national evidence-based guideline for the management of uncomplicated community-acquired pneumonia (CAP) was published and

Relationship between plasma copeptin levels and complications of community-acquired pneumonia in preschool children

High plasma copeptin level has been associated with clinical outcomes after acute illness. The present study was undertaken to investigate the plasma copeptin concentrations in preschool children with community-acquired pneumonia (CAP) and to analyze the correlations of copeptin with CAP-related complications and pleural effusion. Plasma copeptin concentrations of 100 healthy children and 165 preschool children with CAP were measured. 35 children (21.2%) presented with complicated CAP and 28 children (17.0%) presented with pleural effusion. The admission copeptin levels were significantly increased in all patients (49.7±21.4pmol/L), children with complicated CAP (73.0±16.9pmol/L), those with uncomplicated CAP (43.4±17.8pmol/L), those with pleural effusion (70.9±17.4pmol/L) and those without pleural effusion (45.3±19.5pmol/L) compared with healthy control individuals (9.0±2.7pmol/L, all P<0.001). Multivariate logistic regression analysis showed that plasma copeptin levels were independently related to CAP-related complications (odds ratio 1.214, 95% confidence interval 1.104–1.872, P<0.001) and pleural effusion (odds ratio 1.226, 95% confidence interval 1.109–1.917, P<0.001). A receiver operating characteristic curve analysis showed plasma copeptin level better predicted CAP-related complications (area under curve 0.876, 95% confidence interval 0.815–0.922) and pleural effusion (area under curve 0.831, 95% confidence interval 0.765–0.885). Thus, plasma copeptin level may represent a novel biomarker for predicting CAP-related complications in preschool children.