Premium
Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired Pneumonia
Author(s) -
Degelau John,
Guay David,
Straub Kimberly,
Luxenberg Michael G.
Publication year - 1995
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1995.tb07330.x
Subject(s) - medicine , cohort , pneumonia , retrospective cohort study , cohort study
Effectiveness of Oral Antibiotic Treatment in Nursing Home‐Acquired Pneumonia OBJECTIVE : To determine factors associated with success or failure of oral antibiotic treatment for nursing home‐acquired pneumonia (NHAP). DESIGN : Retrospective study of outcomes for all identifiable NHAP cases in 1991. SETTING : The Nursing Home Services Program of St. Paul Ramsey Medical Center and 31 metropolitan St. Paul, Minnesota, community nursing homes. PARTICIPANTS : Nursing home (NH) cohort: 124 patients (mean age 85.2 years) with a new respiratory symptom and new infiltrate on portable chest X‐ray for whom oral antibiotics were prescribed. Hospital cohort: 74 NH patients (mean age 84.3 years) admitted to hospital with new X‐ray infiltrate and pneumonia diagnosis. Supportive care status patients were excluded. Forty‐three physician/nurse practitioner (MD/NP) teams were represented. MEASUREMENTS : Nursing home cohort: Outcomes of hospitalization within 14 days or 30‐day mortality. A discriminant model was applied to predict outcome and discriminant rule performance was analyzed. Hospital cohort: 30‐day mortality. RESULTS : Of 198 episodes of NH pneumonia, 63% were treated in the facility; 30.6% (38) failed NH treatment. Thirty‐day mortality was 13%. There was no examination by the MD or NP for 59% of NH‐treated episodes. The hospital cohort had a higher mean pulse ( P < .05) but a similar frequency of feeding dependence. Hospital cohort mortality was 17.6%. The NH treatment failure group had significantly higher proportions of pulse > 90/min, temperature > 100.5°F, respirations > 30/min, feeding dependence, and mechanically altered diets. A discriminant model using these factors was significant ( P = .002). The NH treatment failure rate was 11% for no factors present, 23% for two or fewer factors, and 59.5% for three or more (likelihood ratio 3.1). Thirty‐two percent of the hospital cohort had zero or one factor present and were alive at 30 days. CONCLUSION : The majority of NHAP episodes were treated successfully with oral antibiotics, but 31% failed treatment in the NH. Patients with a mechanically altered diet or requiring feeding assistance by staff had significantly higher failure rates. Feeding dependence and need for a mechanically altered diet as well as abnormal vital signs are associated with oral antibiotic treatment failure. These factors should be considered in treatment decisions for NHAP. J Am Geriatr Soc 43: 245–251, 1995 .