Skip to main content

Advertisement

SpringerLink
Log in

Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia

  • Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

To determine the causes of treatment failure and to evaluate the prognostic factors in patients hospitalized for community-acquired pneumonia, a prospective, observational study of 228 adult patients hospitalized for a community-acquired pneumonia in the University Hospital of Geneva and the La Chaux-de-Fonds Community Hospital, Switzerland, was conducted. The percentage of patients who failed to improve (as defined by guidelines of the Infectious Disease Society of America) and the causes of treatment failure were assessed, and patients who failed to improve under antimicrobial therapy were compared with those who did improve. In the 54 (24%) patients who failed to improve, a mean increase in length of hospitalization of 4 days was observed. Most causes of treatment failure could be attributed to host factors (61%) rather than to the pathogen (16%) or to an inappropriate antibiotic regimen (3%). After adjusting for potentially confounding variables, concomitant neoplasia (OR 3.25; 95%CI 1.11–9.56), neurological disease (OR 2.34; 95%CI 1.07–5.13), and aspiration pneumonia (OR 2.97; 95%CI 29–6.86]) were associated with failure to improve, whereas monocytosis improved prognosis (OR 0.40; 95%CI 0.20–0.80). Almost one out of four patients hospitalized for community-acquired pneumonia failed to respond to empirical antibiotic treatment. Aspiration pneumonia, concomitant neoplasia, and neurological disease were factors positively associated with failure to improve, whereas monocytosis was linked to a better prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Niederman MS, McCombs JS, Unger AN et al (1998) The cost of treating community-acquired pneumonia. Clin Ther 20:820–837

    PubMed  CAS  Google Scholar 

  2. British Thoracic Society Standards of Care Committee (2001) BTS guidelines for the management of community acquired pneumonia in adults. Thorax 56(Suppl 4):IV1–IV64

    Google Scholar 

  3. Marrie TJ (1998) Community-acquired pneumonia: epidemiology, etiology, treatment. Infect Dis Clin North Am 12:723–740

    PubMed  CAS  Google Scholar 

  4. Bartlett JG, Mundy LM (1995) Community-acquired pneumonia. N Engl J Med 333:1618–1624

    PubMed  CAS  Google Scholar 

  5. Mandell LA, Bartlett JG, Dowell SF et al (2003) Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 37:1405–1433

    PubMed  Google Scholar 

  6. Niederman MS, Mandell LA, Anzueto A et al (2001) Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754

    PubMed  CAS  Google Scholar 

  7. Heffelfinger JD, Dowell SF, Jotgensen JH et al (2000) Management of community-acquired pneumonia in the era of pneumococcal resistance. Arch Intern Med 160:1399–1408

    PubMed  CAS  Google Scholar 

  8. Gleason PP, Kapoor WN, Stone RA et al (1997) Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia. JAMA 278:32–39

    PubMed  CAS  Google Scholar 

  9. Dean NC, Silver MP, Bateman KA et al (2001) Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia. Am J Med 110:451–457

    PubMed  CAS  Google Scholar 

  10. Lim WS, Macfarlane JT, Boswell TCJ et al (2001) Study of community-acquired pneumonia aetiology in adults admitted to hospital: implications for management guidelines. Thorax 56:296–301

    PubMed  CAS  Google Scholar 

  11. Metaly JP, Schultz R, Li Y-H et al (1997) Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med 157:1453–1459

    Google Scholar 

  12. Marrie TJ, Lau CY, Wheeler SL et al (2000) A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA 283:749–755

    PubMed  CAS  Google Scholar 

  13. Petitpretz P, Arvis P, Marcel M et al (2001) Oral moxifloxacin vs high-dosage amoxicillin in the treatment of mild-to-moderate, community-acquired pneumonia in adults. Chest 119:185–195

    PubMed  CAS  Google Scholar 

  14. Fine MJ, Pratt HM, Obrosky DS et al (2000) Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med 109:378–385

    PubMed  CAS  Google Scholar 

  15. Genné D, Kaiser L, Kinge TN et al (2003) Community-acquired pneumonia: causes of treatment failure in patients enrolled in clinical trials. Clin Microb Infect Dis 9:1–6

    Google Scholar 

  16. Roson B, Carratalä J, Fernandez-Sabé N et al (2004) Causes and factors associated with early failure in hospitalized patients with community-acquired pneumonia. Arch Intern Med 164:502–508

    PubMed  Google Scholar 

  17. Arancibia F, Ewig S, Martinez JA et al (2000) Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med 162:154–160

    PubMed  CAS  Google Scholar 

  18. Fine MJ, Auble TE, Yealy DM et al (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250

    PubMed  CAS  Google Scholar 

  19. Torres A, Sera-Battles J, Ferrer A et al (1991) Severe community-acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis 144:312–318

    PubMed  CAS  Google Scholar 

  20. Bartlett JG, Dowell SF, Mandell LA et al (2000) Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 31:347–382

    PubMed  CAS  Google Scholar 

  21. Fine MJ, Smith MA, Carson CA et al (1996) Prognosis and outcomes of patients with community-acquired pneumonia. JAMA 275:134–141

    PubMed  CAS  Google Scholar 

  22. Cunha BA, Ortega AM (1995) Antibiotic failure. Med Clin North Am 79:663–672

    PubMed  CAS  Google Scholar 

  23. Whitney CG, Farley MM, Halder J et al (2000) Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. Active Bacterial Core surveillance program of the Emerging Infections Program Network. N Engl J Med 343:1917–1924

    PubMed  CAS  Google Scholar 

  24. El-Solh AA, Pietrantoni C, Bhat A et al (2003) Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med 167:1650–1654

    PubMed  Google Scholar 

  25. Van Eeden SF, Coetzee AR, Joubert JR (1988) Community-acquired pneumonia: factors influencing intensive care admission. S Afr Med J 73:77–81

    PubMed  Google Scholar 

  26. Klemola E (1973) Cytomegalovirus infection in previously healthy adults. Ann Intern Med 79:267–268

    PubMed  CAS  Google Scholar 

  27. Tsukahara T, Yaguchi A, Horiuchi Y (1992) Significance of monocytosis in varicella and herpes zoster. J Dermatol 19:94–98

    PubMed  CAS  Google Scholar 

  28. Meuret G, Detel U, Kilz HP et al (1975) Human monocytopoiesis in acute and chronic inflammation. Acta Haematol 54:328–335

    Article  PubMed  CAS  Google Scholar 

  29. Turpin JA, Lopez-Berestein G (1993) Differentiation, maturation, and activation of monocytes and macrophages: functional activity is controlled by a continuum of activation. In: Lopez-Berestein G, Klostergaard J (eds) Mononuclear phagocytes in cell biology. CRC, Boca Raton, Florida, pp 71–76

    Google Scholar 

  30. Menedez R, Torrez A, Zalacain R et al (2004) Risk factors of treatment failure in community-acquired pneumonia: implications for disease outcome. Thorax 59:960–965

    Google Scholar 

  31. Dedier J, Singer DE, Chang Y, Moore M, Atlas SJ (2001) Processes of care, illness severity, and outcome in the management of community-acquired pneumonia at academic hospitals. Arch Intern Med 161:2099–2104

    PubMed  CAS  Google Scholar 

  32. Halm EA, Fine MJ, Marrie TJ, Coley CM, Kapoor WN, Obrosky DS, Singer DE (1998) Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 279:1452–1457

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would particularly like to thank Dr. Carmen Pessoa Da Silva for her assistance in the statistical analysis in this study and Valentina Kostina for reviewing and helping with the preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Medicine, Hôpital de la Ville, La Chaux-de-Fonds Hospital, 2300, La Chaux-de-Fonds, Switzerland

    D. Genné & A. Pasche

  2. Division of Infectious Diseases, Department of Medicine, University of Geneva Hospitals, Geneva, Switzerland

    R. Sommer, L. Kaiser, A. Saaïdia & D. Lew

  3. Accident and Emergency Unit, University Hospitals of Geneva, Geneva, Switzerland

    P. F. Unger

Authors
  1. D. Genné
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Sommer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Saaïdia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Pasche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. F. Unger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Genné.

Additional information

The results of this study were presented at the 11th International Congress on Infectious Diseases, March 2004, Cancun, Mexico.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Genné, D., Sommer, R., Kaiser, L. et al. Analysis of factors that contribute to treatment failure in patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 25, 159–166 (2006). https://doi.org/10.1007/s10096-006-0113-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-006-0113-3

Keywords

Search

Navigation