Methods: We performed a retrospective electronic health record review of all adult patients admitted to the Queen’s Medical Center with a diagnosis of HCAP from January 1, 2013 to December 31, 2014. Patient demographics, comorbidities, microbiologic data, infectious diseases specialty consultation, assignment to resident teams, and data elements for pneumonia severity index (PSI) and CURB-65 scores were collected. Patients were followed for de-escalation for a maximum of 5 days. A logistic regression model was used for analysis.
Results: A chart review revealed 217 cases admitted to the non-ICU setting with pneumonia and subsequent positive blood cultures and/or sputum cultures. Seventy-four cases met predetermined criteria for HCAP, with 58 (78.4%) cases having been de-escalated. In univariate analysis, factors associated with the implementation of de-escalation included antibiotic use within 30 days of admission (OR, 3.11, CI 1.09-9.84; p<0.05), malignancy (OR, 5.29, CI 1.34-35.5; p<0.05), assignment to resident teams (OR, 6.77, CI 1.73-45.3; p<0.05), and PSI score (OR, 0.987, CI 0.973-1.00; p<0.05). De-escalation was associated with low in-hospital mortality (p<0.05) and high number of hospital free-days (p<0.05). Even in higher severity defined as PSI risk class V (OR, 0.148, CI 0.0187-0.800; p<0.05), de-escalation was associated with decreased mortality.
Conclusion: De-escalation occurred in patients who were less ill. However, de-escalation may benefit mortality regardless of severity.
Z. Zhang, None
N. Klomjit, None
H. Chung, None
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