caa a22 4500 606156380 CHVBK 20210128100608.0 cr unu---uuuuu 210128e20150301xx s 000 0 eng 10.1007/s10096-014-2254-0 doi (NATIONALLICENCE)springer-10.1007/s10096-014-2254-0 Community-acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins [Elektronische Daten] [J. Pradelli, K. Risso, F. de Salvador, E. Cua, R. Ruimy, P.-M. Roger] Guidelines for inpatients with community-acquired pneumonia (CAP) propose to use respiratory fluoroquinolone (RFQ) and/or third-generation cephalosporins (Ceph-3). However, broad-spectrum antibiotic therapy is associated with the emergence of drug-resistant bacteria. We established a guideline in which RFQ and Ceph-3 were excluded as a first course. Our aim was to evaluate the impact of our therapeutic choices for CAP on the length of hospital stay (LOS) and patient outcome. This was a cohort study of patients with CAP from July 2005 to June 2014. We compared patients benefiting from our guideline established in 2008 to those receiving non-consensual antibiotics. Disease severity was evaluated through the Pneumonia Severity Index (PSI). The empirical treatment for PSI III to V was a combination therapy of amoxicillin-clavulanic acid (AMX-C) + roxithromycin (RX) or AMX + ofloxacin. Adherence to guidelines was defined by the prescription of one of these antibiotic agents. Requirement for intensive care or death defined unfavorable outcome. Among 1,370 patients, 847 were treated according to our guideline (61.8%, group 1) and 523 without concordant therapy (38.2%, group 2). The mean PSI was similar: 82 vs. 83, p > 0.5. The mean LOS was lower in group 1: 7.6days vs. 9.1 days, p < 0.001. An unfavorable outcome was less frequent in group 1: 5.4% vs. 9.9%, p = 0.001. In logistic regression models, concordant therapy was associated with a favorable outcome: adjusted odds ratio (AOR) [95 % confidence interval (CI)] 1.85 [1.20-2.88], p = 0.005. CAP therapy without RFQ and Ceph-3 use was associated with a shorter LOS and fewer unfavorable outcomes. Springer-Verlag Berlin Heidelberg, 2014 Pradelli J. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut Risso K. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut de Salvador F. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut Cua E. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut Ruimy R. Bactériologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France aut Roger P.-M Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/3(2015-03-01), 511-518 0934-9723 34:3<511 2015 34 10096 https://doi.org/10.1007/s10096-014-2254-0 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-014-2254-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Pradelli J. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut NATIONALLICENCE 700 1- Risso K. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut NATIONALLICENCE 700 1- de Salvador F. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut NATIONALLICENCE 700 1- Cua E. Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut NATIONALLICENCE 700 1- Ruimy R. Bactériologie, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, Nice, France aut NATIONALLICENCE 700 1- Roger P.-M Infectiologie, Hôpital de l'Archet 1, Centre Hospitalier Universitaire de Nice, Université de Nice Sophia-Antipolis, BP 3079, 06202, Nice, France aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/3(2015-03-01), 511-518 0934-9723 34:3<511 2015 34 10096