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Published in: BMC Pulmonary Medicine 1/2017

Open Access 01-12-2017 | Research article

Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark: a retrospective cohort study

Authors: Gertrud Baunbæk Egelund, Andreas Vestergaard Jensen, Stine Bang Andersen, Pelle Trier Petersen, Bjarne Ørskov Lindhardt, Christian von Plessen, Gernot Rohde, Pernille Ravn

Published in: BMC Pulmonary Medicine | Issue 1/2017

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Abstract

Background

Community-acquired pneumonia (CAP) is a severe infection, with high mortality. Antibiotic strategies for CAP differ across Europe.
The objective of the study was to describe the epidemiology of CAP in Denmark and evaluate the prognosis of patients empirically treated with penicillin-G/V monotherapy.

Methods

Retrospective cohort study including hospitalized patients with x-ray confirmed CAP. We calculated the population-based incidence, reviewed types of empiric antibiotics and duration of antibiotic treatment. We evaluated the association between mortality and treatment with empiric penicillin-G/V using logistic regression analysis.

Results

We included 1320 patients. The incidence of hospitalized CAP was 3.1/1000 inhabitants. Median age was 71 years (IQR; 58–81) and in-hospital mortality was 8%. Median duration of antibiotic treatment was 10 days (IQR; 8–12). In total 45% were treated with penicillin-G/V as empiric monotherapy and they did not have a higher mortality compared to patients treated with broader-spectrum antibiotics (OR 0.92, CI 95% 0.55–1.53).

Conclusion

The duration of treatment exceeded recommendations in European guidelines. Empiric monotherapy with penicillin-G/V was commonly used and not associated with increased mortality in patients with mild to moderate pneumonia. Our results are in agreement with current conservative antibiotic strategy as outlined in the Danish guidelines.
Literature
1.
go back to reference Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67(1):71–9.CrossRefPubMed Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67(1):71–9.CrossRefPubMed
2.
go back to reference Blasi F, Mantero M, Santus P, Tarsia P. Understanding the burden of pneumococcal disease in adults. Clin Microbiol Infect. 2012;18 Suppl 5:7–14.CrossRefPubMed Blasi F, Mantero M, Santus P, Tarsia P. Understanding the burden of pneumococcal disease in adults. Clin Microbiol Infect. 2012;18 Suppl 5:7–14.CrossRefPubMed
3.
go back to reference Marti C, Garin N, Grosgurin O, Poncet A, Combescure C, Carballo S, Perrier A. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Crit Care. 2012;16(4):R141.CrossRefPubMedPubMedCentral Marti C, Garin N, Grosgurin O, Poncet A, Combescure C, Carballo S, Perrier A. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Crit Care. 2012;16(4):R141.CrossRefPubMedPubMedCentral
4.
go back to reference Bewick T, Sheppard C, Greenwood S, Slack M, Trotter C, George R, Lim WS. Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia. Thorax. 2012;67(6):540–5.CrossRefPubMed Bewick T, Sheppard C, Greenwood S, Slack M, Trotter C, George R, Lim WS. Serotype prevalence in adults hospitalised with pneumococcal non-invasive community-acquired pneumonia. Thorax. 2012;67(6):540–5.CrossRefPubMed
5.
go back to reference Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L, CDC EPIC Study Team. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015;373(5):415–27.CrossRefPubMedPubMedCentral Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD, Qi C, Hart EM, Carroll F, Trabue C, Donnelly HK, Williams DJ, Zhu Y, Arnold SR, Ampofo K, Waterer GW, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, McCullers JA, Pavia AT, Edwards KM, Finelli L, CDC EPIC Study Team. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults. N Engl J Med. 2015;373(5):415–27.CrossRefPubMedPubMedCentral
6.
go back to reference Ewig S, Birkner N, Strauss R, Schaefer E, Pauletzki J, Bischoff H, Schraeder P, Welte T, Hoeffken G. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax. 2009;64(12):1062–9.CrossRefPubMedPubMedCentral Ewig S, Birkner N, Strauss R, Schaefer E, Pauletzki J, Bischoff H, Schraeder P, Welte T, Hoeffken G. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax. 2009;64(12):1062–9.CrossRefPubMedPubMedCentral
7.
go back to reference Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point-prevalence survey of antimicrobial use across Europe. Drugs. 2011;71(6):745–55.CrossRefPubMed Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point-prevalence survey of antimicrobial use across Europe. Drugs. 2011;71(6):745–55.CrossRefPubMed
8.
go back to reference Spindler C, Stralin K, Eriksson L, Hjerdt-Goscinski G, Holmberg H, Lidman C, Nilsson A, Ortqvist A, Hedlund J, Community Acquired Pneumonia Working Group of The Swedish Society of Infectious Diseases. Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults--Swedish Society of Infectious Diseases 2012. Scand J Infect Dis. 2012;44(12):885–902.CrossRefPubMed Spindler C, Stralin K, Eriksson L, Hjerdt-Goscinski G, Holmberg H, Lidman C, Nilsson A, Ortqvist A, Hedlund J, Community Acquired Pneumonia Working Group of The Swedish Society of Infectious Diseases. Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults--Swedish Society of Infectious Diseases 2012. Scand J Infect Dis. 2012;44(12):885–902.CrossRefPubMed
9.
go back to reference Huijts SM, van Werkhoven CH, Boersma WG, Buijs J, Buunk G, Compaijen CJ, van Elde LJ, Gisolf JE, van der Kam R, Kluytmans JA, Kuipers BA, Mager JJ, Oppedijk B, Palmen F, Prins JM, van Reemst B, Silbermann MH, van Tiel FH, van der Wall E, van der Werf TS, Bonten MJ. Guideline adherence for empirical treatment of pneumonia and patient outcome. Treating pneumonia in the Netherlands. Neth J Med. 2013;71(10):502–7. Huijts SM, van Werkhoven CH, Boersma WG, Buijs J, Buunk G, Compaijen CJ, van Elde LJ, Gisolf JE, van der Kam R, Kluytmans JA, Kuipers BA, Mager JJ, Oppedijk B, Palmen F, Prins JM, van Reemst B, Silbermann MH, van Tiel FH, van der Wall E, van der Werf TS, Bonten MJ. Guideline adherence for empirical treatment of pneumonia and patient outcome. Treating pneumonia in the Netherlands. Neth J Med. 2013;71(10):502–7.
10.
go back to reference Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ, Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1–E59.CrossRefPubMed Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ, Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections--full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1–E59.CrossRefPubMed
11.
go back to reference Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA, Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;Suppl 3:iii1–iii55. Lim WS, Baudouin SV, George RC, Hill AT, Jamieson C, Le Jeune I, Macfarlane JT, Read RC, Roberts HJ, Levy ML, Wani M, Woodhead MA, Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;Suppl 3:iii1–iii55.
12.
go back to reference Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis. Clin Infect Dis. 2014;58(3):330–9.CrossRefPubMed Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis. Clin Infect Dis. 2014;58(3):330–9.CrossRefPubMed
13.
go back to reference Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O’Grady NP, Bartlett JG, Carratala J, El Solh AA, Ewig S, Fey PD, File Jr TM, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61–e111.CrossRefPubMed Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O’Grady NP, Bartlett JG, Carratala J, El Solh AA, Ewig S, Fey PD, File Jr TM, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61–e111.CrossRefPubMed
14.
go back to reference Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–82.CrossRefPubMedPubMedCentral Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–82.CrossRefPubMedPubMedCentral
15.
go back to reference Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065–79.CrossRefPubMedPubMedCentral Torres A, Blasi F, Peetermans WE, Viegi G, Welte T. The aetiology and antibiotic management of community-acquired pneumonia in adults in Europe: a literature review. Eur J Clin Microbiol Infect Dis. 2014;33(7):1065–79.CrossRefPubMedPubMedCentral
16.
go back to reference Blasi F, Garau J, Medina J, Avila M, McBride K, Ostermann H, REACH study group. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res. 2013;14:44.CrossRefPubMedPubMedCentral Blasi F, Garau J, Medina J, Avila M, McBride K, Ostermann H, REACH study group. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res. 2013;14:44.CrossRefPubMedPubMedCentral
17.
go back to reference Kirk O, Glenthoj J, Dragsted UB, Helweg-Larsen J, Aru TM, Benfield TL, Jensen K, Vestbo J, Lundgren JD. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital. Dan Med Bull. 2001;48(2):84–8.PubMed Kirk O, Glenthoj J, Dragsted UB, Helweg-Larsen J, Aru TM, Benfield TL, Jensen K, Vestbo J, Lundgren JD. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital. Dan Med Bull. 2001;48(2):84–8.PubMed
18.
go back to reference Mortensen EM, Coley CM, Singer DE, Marrie TJ, Obrosky DS, Kapoor WN, Fine MJ. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 2002;162(9):1059–64.CrossRefPubMed Mortensen EM, Coley CM, Singer DE, Marrie TJ, Obrosky DS, Kapoor WN, Fine MJ. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med. 2002;162(9):1059–64.CrossRefPubMed
19.
go back to reference Sintes H, Sibila O, Waterer G, Chalmers J. Severity assessment tools. In: Chalmers J, Pletz M, Aliberti S, editors. European respiratory monograph; community-acquired pneumonia. European Respiratory Society Publications; 2014:88. Sintes H, Sibila O, Waterer G, Chalmers J. Severity assessment tools. In: Chalmers J, Pletz M, Aliberti S, editors. European respiratory monograph; community-acquired pneumonia. European Respiratory Society Publications; 2014:88.
20.
go back to reference Reissig A, Mempel C, Schumacher U, Copetti R, Gross F, Aliberti S. Microbiological diagnosis and antibiotic therapy in patients with community-acquired pneumonia and acute COPD exacerbation in daily clinical practice: comparison to current guidelines. Lung. 2013;191(3):239–46.CrossRefPubMed Reissig A, Mempel C, Schumacher U, Copetti R, Gross F, Aliberti S. Microbiological diagnosis and antibiotic therapy in patients with community-acquired pneumonia and acute COPD exacerbation in daily clinical practice: comparison to current guidelines. Lung. 2013;191(3):239–46.CrossRefPubMed
21.
go back to reference Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs. 2008;68(13):1841–54.CrossRefPubMed Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME. Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs. 2008;68(13):1841–54.CrossRefPubMed
22.
go back to reference Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis. 2011;52(10):1232–40.CrossRefPubMed Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis. 2011;52(10):1232–40.CrossRefPubMed
23.
go back to reference Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120(9):783–90.CrossRefPubMed Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120(9):783–90.CrossRefPubMed
24.
go back to reference Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K, Competence Network for Community-Acquired Pneumonia study group. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J. 2008;32(1):139–46.CrossRefPubMed Kothe H, Bauer T, Marre R, Suttorp N, Welte T, Dalhoff K, Competence Network for Community-Acquired Pneumonia study group. Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J. 2008;32(1):139–46.CrossRefPubMed
25.
go back to reference Bauer TT, Ewig S, Marre R, Suttorp N, Welte T, CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260(1):93–101.CrossRefPubMed Bauer TT, Ewig S, Marre R, Suttorp N, Welte T, CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006;260(1):93–101.CrossRefPubMed
26.
go back to reference Aliberti S, Ramirez J, Cosentini R, Brambilla AM, Zanaboni AM, Rossetti V, Tarsia P, Peyrani P, Piffer F, Blasi F. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. 2011;105(11):1732–8.CrossRefPubMed Aliberti S, Ramirez J, Cosentini R, Brambilla AM, Zanaboni AM, Rossetti V, Tarsia P, Peyrani P, Piffer F, Blasi F. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. 2011;105(11):1732–8.CrossRefPubMed
27.
go back to reference Chalmers JD, Mandal P, Singanayagam A, Akram AR, Choudhury G, Short PM, Hill AT. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med. 2011;37(9):1409–20.CrossRefPubMed Chalmers JD, Mandal P, Singanayagam A, Akram AR, Choudhury G, Short PM, Hill AT. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med. 2011;37(9):1409–20.CrossRefPubMed
28.
go back to reference Kolditz M, Ewig S, Schutte H, Suttorp N, Welte T, Rohde G, the CAPNETZ study group: Assessment of oxygenation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score. J Intern Med. 2015;278(2):193–202. Kolditz M, Ewig S, Schutte H, Suttorp N, Welte T, Rohde G, the CAPNETZ study group: Assessment of oxygenation and comorbidities improves outcome prediction in patients with community-acquired pneumonia with a low CRB-65 score. J Intern Med. 2015;278(2):193–202.
Metadata
Title
Penicillin treatment for patients with Community-Acquired Pneumonia in Denmark: a retrospective cohort study
Authors
Gertrud Baunbæk Egelund
Andreas Vestergaard Jensen
Stine Bang Andersen
Pelle Trier Petersen
Bjarne Ørskov Lindhardt
Christian von Plessen
Gernot Rohde
Pernille Ravn
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2017
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-017-0404-8

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