Initial Empiric Antibiotic Therapy For Community-acquired Pneumonia In The Elderly

ObjectiveThe purpose of this study was to investigate empiric antibiotic practices for elderly patients hospitalized with community-acquired pneumonia(CAP)and the risk factors for empiric treatment failure.MethodsData were collected from hospitalization database of a tertiary hospital.A total of 84 elderly patients who were diagnosed with CAP between November 1,2018 to October 30,2019 were identified.The basic clinical data,microbiologic sampling,initial empiric antibiotic regimens,length of stay and in-hospital mortality were collected to study the risk factors for the failure of initial anti-infective treatment.ResultsThere were 84 elderly patients who met all the study inclusion criteria.The microbiologic detection rate was 82.1%(69/84).The most common initial antibiotic regimen for CAP was monotherapy with a β-lactam with anti-pseudomonas activity(23.8%),The most common initial antibiotic(used alone or in combination with other antibiotics)was moxifloxacin(25.1%,36/143(this denominator represents the total number of initial antibiotics)).A total of 47(55.9%)of 84 patients experienced treatment failure.In-hospital mortality was 7.1%(6/84).The median hospital length of stay was 14 days(interquartile range,10-23days).Multivariate logistic regression demonstrated that admission to intensive care unit(ICU),coexisting chronic obstructive pulmonary disease(COPD)and hypertension disease were risk factors for treatment failure.ConclusionMonotherapy with a β-lactam with anti-Pseudomonas activity was the most commonly used initial antibiotic regimen in elderly patients with CAP.Admission to ICU,coexisting chronic obstructive pulmonary disease and hypertension disease may be risk factors for failure of initial treatment.Patients receiving successful initial empirical treatment were associated with shorter length of hospital stay.