Health care-associated pneumonia in haemodialysis patients: Clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy
Article first published online: 25 JAN 2013
© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology
Volume 18, Issue 2, pages 364–368, February 2013
How to Cite
TAYLOR, S. P. and TAYLOR, B. T. (2013), Health care-associated pneumonia in haemodialysis patients: Clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy. Respirology, 18: 364–368. doi: 10.1111/j.1440-1843.2012.02306.x
- Issue published online: 25 JAN 2013
- Article first published online: 25 JAN 2013
- Accepted manuscript online: 16 OCT 2012 02:03AM EST
- Received 23 May 2012; invited to revise 17 June, 29 July 2012; revised 15 July, 12 August 2012; accepted 19 August 2012 (Associate Editor: Yuben Moodley).
- antibiotic guideline;
- health care-associated pneumonia
Background and objective: Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care-associated pneumonia (HCAP), and thus recommend treatment with broad-spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad-spectrum antibiotics versus narrow-spectrum antibiotics.
Methods: One hundred twenty-five haemodialysis patients with pneumonia met eligibility criteria. Categorization into the community-acquired pneumonia (CAP) group or HCAP group was based on antibiotic therapy patients received. Time to oral therapy, time to clinical stability, length of stay and mortality were compared.
Results: CAP and HCAP patients did not differ in Pneumonia Severity Index and Charlson Comorbidity index scores, but HCAP patients were more likely to meet criteria for severe pneumonia. Patients treated with HCAP therapy had a significantly longer time to oral therapy than CAP patients (9.2 vs 3.2 days, P < 0.001) and a significantly longer length of stay (11.9 vs 5.1 days, P < 0.001). Time to clinical stability was marginally longer in the HCAP group (3.1 vs 2.4 days, P = 0.07). Patients treated with HCAP therapy had longer continuation of intravenous antibiotics after reaching clinical stability (5.5 vs 0.78 days, P < 0.001).
Conclusions: This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow-spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de-escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay.