The new study presented at the 2017 American Thoracic Society International Conference has found that about 22.1%, approximately one in four adults, failed to respond to antibiotics for community-acquired pneumonia (CAP) treatment.
Streptococcus pneumoniae. Credit: ktsdesign/Shutterstock.com
"Pneumonia is the leading cause of death from infectious disease in the United States, so it is concerning that we found nearly one in four patients with community-acquired pneumonia required additional antibiotic therapy, subsequent hospitalization or emergency room evaluation," said lead author James A. McKinnell, MD, an LA BioMed (Los Angeles, CA) lead researcher and infectious disease specialist.
"The additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile ("C diff") infection, which is difficult to treat and may be life-threatening, especially for older adults."
In 2007, the American Thoracic Society and the Infectious Disease Society of America published guidelines for community-acquired pneumonia. Though it has provided some direction, Dr. McKinnell and colleagues conducted this study to better understand the large-scale, real-world data, and to optimize the choice of antibiotics and better define clinical risk factors which may be connected with the failure of the treatment.
The research team inspected the data of 251,947 adult outpatients who were treated with a single class of antibiotics following a visit to their physician for community-acquired pneumonia treatment between 2011 and 2015. Upon receipt of the initial prescription for the antibiotic, the researchers defined when there is either antibiotic refill, antibiotic switch, ER visit, or hospitalization within 30 days as antibiotic treatment failure.
The total drug failure rate was 22.1 percent. The antibiotic drug failure rates were higher in patients with certain characteristics such as older patients or having various diseases in addition to pneumonia. After adjusting for baseline patient characteristics, it was found the highest antibiotic failure rate of 25.7%.
"Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure," said Dr. McKinnell.
Our data provide numerous insights into characteristics of patients who are at higher risk of complications and clinical failure. Perhaps the most striking example is the association between age and hospitalization: Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy."
James A. McKinnell, MD
He also stated that this study has found considerable regional variations in treatment outcome, which are not addressed in a specific way in the guidelines of CAP. Additionally, the study showed that patients with comorbidities such as chronic obstructive pulmonary disease, cancer, or diabetes were not treated in combination with antibiotic therapy or respiratory fluoroquinolone as recommended by the guidelines.
Dr. McKinnell concluded: "While certain aspects of the guidelines need to be updated, some prescribers also have room for improvement and should implement the current guidelines."