According to the National Alliance on Mental Illness, 1 in 5 American adults experiences a mental health condition every year. CAP is often treated with antibiotics that can prolong the QTc interval. The primary outcome was to assess whether those with a psychiatric disorder were more likely to experience treatment failure and have poor outcomes in the treatment of community acquired pneumonia (CAP).
A retrospective chart review was performed using ICD-9/10 codes for CAP between January 1st, 2008 and January 31st, 2018. Patients were included if they were seen at the Western New York VA Healthcare System, emergency room, primary or rural care clinics. Data was analyzed via the Student’s t-test or Chi-Squared test.
A total of 518 patients met criteria and 49% had a psychiatric disorder. Compared to patients without psychiatric disorders, patients with psychiatric co-morbidity were more likely to receive an appropriate dose of antibiotics (99.4% vs. 93.6% p= 0.0004) as well as an appropriate duration (78% vs 68% p=0.03). Patients with a psychiatric disorder were not more likely to experience failure or subsequent admission. There was no statically significant difference in early or late CAP treatment failure in those with a psychiatric disorder compared to those without (p=0.3383; p=0.116). There was also no statistically significant difference in 30-day readmission rates, 30-day mortality, or 90-day mortality (p=0.4095; p=0.3383; p=0.3790). They were more likely to be prescribed conditional risk QTc prolonging agents concomitantly (70.2% vs 26.9% p<0.0001), however, differences in prescribing rates of a QTc prolonging antibiotic, such as a fluoroquinolone or macrolide, were not statistically significant (85.3% vs. 83.4% p= 0.5353).
While mental illness is often associated with poor outcomes, this study emphasizes the need to continue to remove the stigma of mental illness when treating patients with common outpatient infections.
B. Wattengel, None
R. Napierala, None
J. Sellick, None
J. Schroeck, None