Timing of Antibiotic Administration and Outcomes for Medicare Patients Hospitalized With Community-Acquired Pneumonia

TLDR

Pneumonia causes over 600 000 Medicare hospitalizations annually, and guidelines recommend initiating antibiotics within 8 hours of hospital arrival. The authors conducted a retrospective analysis of 18 209 Medicare patients aged >65 hospitalized with community‑acquired pneumonia from July 1998 to March 1999, evaluating severity‑adjusted mortality, 30‑day readmission, and length of stay. In this cohort of 13 771 patients, antibiotics started within 4 hours of admission lowered in‑hospital mortality (6.8 % vs 7.4 %), 30‑day mortality (11.6 % vs 12.7 %), and the proportion with length of stay >5 days (42.1 % vs 45.1 %), shortened mean LOS by 0.4 days, and had no effect on 30‑day readmission.

Abstract

<h3>Background</h3> Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital. <h3>Methods</h3> We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999. Outcomes were severity-adjusted mortality, readmission within 30 days of discharge, and length of stay (LOS). <h3>Results</h3> Among 13 771 (75.6%) patients who had not received outpatient antibiotic agents, antibiotic administration within 4 hours of arrival at the hospital was associated with reduced in-hospital mortality (6.8% vs 7.4%; adjusted odds ratio [AOR], 0.85; 95% confidence interval [CI], 0.74-0.98), mortality within 30 days of admission (11.6% vs 12.7%; AOR, 0.85; 95% CI, 0.76-0.95), and LOS exceeding the 5-day median (42.1% vs 45.1%; AOR, 0.90; 95% CI, 0.83-0.96). Mean LOS was 0.4 days shorter with antibiotic administration within 4 hours than with later administration. Timing was not associated with readmission. Antibiotic administration within 4 hours of arrival was documented for 60.9% of all patients and for more than 50% of patients regardless of hospital characteristics. <h3>Conclusions</h3> Antibiotic administration within 4 hours of arrival was associated with decreased mortality and LOS among a random sample of older inpatients with community-acquired pneumonia who had not received antibiotics as outpatients. Administration within 4 hours can prevent deaths in the Medicare population, offers cost savings for hospitals, and is feasible for most inpatients.