Community-acquired pneumonia (CAP) is a major health problem in the United States. As well as being the seventh leading cause of death, the estimated financial cost of treating CAP in the United States exceeds 12 billion dollars per year.
Two retrospective analyses of large Medicare databases identified the time between presentation to the hospital and the time to the first antibiotic dose (TFAD) as a significant predictor of outcome.
Both of these studies have inconsistencies, particularly the higher mortality rate among those receiving antibiotics within 2 h. However, the findings of these studies have convinced national regulatory bodies in the United States to make TFAD a benchmark for quality of care in patients with CAP. www.cfm-online-shop.com
A reasonable biological explanation for why a difference of a few hours in antibiotic administration should lead to a better outcome has not been established. Historical data strongly indicate that antibiotics take several days to impact on outcome from pneumococcal pneumonia. Possible explanations include confounding factors inadequately accounted for in the retrospective database reviews and TFAD being a surrogate marker for other quality-of-care factors.
While the use of large Medicare databases has advantages with respect to statistical power and the ability to generalize findings across broader populations, clear disadvantages occur with respect to the loss of detailed individual clinical data and the loss of surety of diagnosis inherent in prospective clinical trials. We analyzed our prospectively collected cohort of patients with CAP specifically examining the clinical factors influencing TFAD.
A prospective cohort of patients admitted to the Methodist Healthcare-Memphis Hospitals with CAP between November 1998 and July 2001 was recruited. Informed consent was obtained from all patients. The Methodist Healthcare Institutional review board approved the study.