Presented at the 21st Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, Dallas, TX, April 2011.
Risk Factors for Drug-resistant Streptococcus pneumoniae and Antibiotic Prescribing Practices in Outpatient Community-acquired Pneumonia
Article first published online: 25 MAY 2012
© 2012 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 19, Issue 6, pages 703–706, June 2012
How to Cite
Jenkins, T. C., Sakai, J., Knepper, B. C., Swartwood, C. J., Haukoos, J. S., Long, J. A., Price, C. S. and Burman, W. J. (2012), Risk Factors for Drug-resistant Streptococcus pneumoniae and Antibiotic Prescribing Practices in Outpatient Community-acquired Pneumonia. Academic Emergency Medicine, 19: 703–706. doi: 10.1111/j.1553-2712.2012.01365.x
This work was supported by the Department of Patient Safety and Quality, Denver Health Medical Center. Dr. Haukoos was supported by an Independent Scientist Award (K02 HS017526) from the Agency of Healthcare Research and Quality. The authors have no potential conflicts of interest to disclose.
Supervising Editor: Sandy Bogucki, MD, PhD.
- Issue published online: 11 JUN 2012
- Article first published online: 25 MAY 2012
- Received September 27, 2011; revision received November 30, 2011; accepted January 2, 2012.
ACADEMIC EMERGENCY MEDICINE 2012; 19:703–706 © 2012 by the Society for Academic Emergency Medicine
Objectives: Due to antimicrobial resistance in Streptococcus pneumoniae, national guidelines recommend a respiratory fluoroquinolone or combination antimicrobial therapy for outpatient treatment of community-acquired pneumonia (CAP) associated with risk factors for drug-resistant S. pneumoniae (DRSP). The objectives of this study were to assess the prevalence of these risk factors and antibiotic prescribing practices in cases of outpatient CAP treated in the acute care setting.
Methods: This was a retrospective cohort study of adult outpatients treated for CAP in the emergency department (ED) or urgent care center of an urban, academic medical center from May 1, 2009, through October 31, 2009, and comparison of antibiotic therapy in cases with and without DRSP risk factors.
Results: Of 175 patients, 90 (51%) had at least one DRSP risk factor, most commonly asthma (n = 28, 16%), alcohol abuse (n = 24, 14%), diabetes mellitus (n = 18, 10%), chronic obstructive pulmonary disease (n = 16, 9%), age > 65 years (n = 16, 9%), and use of antibiotics within 3 months (15, 9%). Antibiotic prescriptions were similar among cases with and without DRSP risk factors: a macrolide (62% vs. 59%, respectively, p = 0.65), doxycycline (27% vs. 28%, p = 0.82), or a respiratory fluoroquinolone (9% vs. 9%, p = 0.90). Concordance with national guideline treatment recommendations was significantly lower in cases with DRSP risk factors (9% vs. 87%, p < 0.0001).
Conclusions: DRSP risk factors were present in approximately half of outpatient CAP cases treated in the acute care setting; however, guideline-concordant antibiotic therapy was infrequent. Strict adherence to current guidelines would substantially increase use of fluoroquinolones or combination therapy. Whether the potential risks associated with these broad-spectrum regimens are justified by improved clinical outcomes requires further study.