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Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome
  1. R Menéndez1,
  2. A Torres2,
  3. R Zalacaín3,
  4. J Aspa4,
  5. J J Martín Villasclaras5,
  6. L Borderías6,
  7. J M Benítez Moya7,
  8. J Ruiz-Manzano8,
  9. F Rodríguez de Castro9,
  10. J Blanquer10,
  11. D Pérez10,
  12. C Puzo11,
  13. F Sánchez Gascón12,
  14. J Gallardo13,
  15. C Álvarez14,
  16. L Molinos15,
  17. (Neumofail Group)
  1. 1Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
  2. 2Instituto de Neumología y Alergia, Hospital Clinic, Barcelona, Spain
  3. 3Servicio de Neumología, Hospital de Cruces, Bilbao, Spain
  4. 4Servicio de Neumología, Hospital de la Princesa, Madrid, Spain
  5. 5Servicio de Neumología, Hospital Carlos Haya, Malaga, Spain
  6. 6Servicio de Neumología, Hospital San Jorge, Huesca, Spain
  7. 7Servicio de Neumología, Hospital Virgen de la Macarena, Sevilla, Spain
  8. 8Servicio de Neumología, H Germans Trias i Pujol, Badalona, Spain
  9. 9Servicio de Neumología, Hospital Dr Negrín, Las Palmas de Gran Canaria, Spain
  10. 10Cuidados Intensivos, Servicio de Neumología, Hospital Clínico, Valencia, Spain
  11. 11Servicio de Neumología, Hospital San Pablo, Barcelona, Spain
  12. 12Servicio de Neumología, Hospital General Universitario, Murcia, Spain
  13. 13Servicio de Neumología, Hospital General, Guadalajara, Spain
  14. 14Servicio de Neumología, Hospital 12 de Octubre, Madrid, Spain
  15. 15Servicio de Neumología, Hospital Ntra Sra de Covadonga, Oviedo, Spain
  1. Correspondence to:
    Dr R Menéndez
    Servicio de Neumología, Hospital Universitario La Fe, Avda de Campanar 21, Valencia 46009, Spain;


Background: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome.

Methods: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded.

Results: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class.

Conclusions: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

  • CAP, community acquired pneumonia
  • PSI, pneumonia severity index
  • Community acquired pneumonia
  • antimicrobial treatment
  • failure
  • mortality
  • risk factors
  • prognosis

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  • This study was supported by a grant from SEPAR (Sociedad Española de Neumología y Cirugía Torácica) and Pfizer Spain. The analysis of data was carried out with the support of Red-Respira (RTIC C03/11).

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