Clinical Outcomes of Hospital-Acquired and Healthcare-Associated Pneumonia With and Without Empiric Vancomycin in a Noncritically Ill Population

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Abstract

Background

Recent evidence suggests that not all patients diagnosed with hospital-acquired pneumonia (HAP) and healthcare-associated pneumonia (HCAP) are at risk for methicillin-resistant Staphylococcus aureus. The objective of the study was to examine outcomes of noncritically ill HAP/HCAP patients who received empiric vancomycin compared with those who did not.

Methods

This was a multicenter retrospective cohort study. Chart review was used to identify HAP/HCAP patients for study inclusion. Treatment groups were patients who received empiric vancomycin versus those who did not. Primary outcome was clinical success at the time of antibiotic completion or discharge for pneumonia treatment. Secondary outcomes included c, time to clinical stability, all-cause mortality, time to antibiotic de-escalation, and 30-day readmission rates for pneumonia. Safety was examined by rates of nephrotoxicity.

Results

A total of 279 patients met study criteria (105 vancomycin vs. 174 nonvancomycin). There was no significant difference in clinical success (vancomycin 93.3% vs. nonvancomycin 96.6%; P = 0.124). The vancomycin group had longer length of stay (P < 0.001) and time to therapy deescalation (P < 0.001). No significant difference was observed in hospital all-cause mortality and 30-day readmission for pneumonia. Patients who did not receive vancomycin reached clinical stability faster. Rate of nephrotoxicity was similar between both groups (vancomycin 33.3% vs nonvancomycin 28.7%; P = 0.437).

Conclusions

No difference in clinical success was observed for empiric vancomycin therapy. This study supports the updated HAP guideline that empiric vancomycin therapy may not be necessary in this population.

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