Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study
Background - Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this...
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ftunivtroemsoe:oai:munin.uit.no:10037/18777 2023-05-15T17:39:25+02:00 Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study Høgli, June Utnes Garcia, Beate Hennie Svendsen, Kristian Skogen, Vegard Småbrekke, Lars 2020-06-15 https://hdl.handle.net/10037/18777 https://doi.org/10.1186/s12890-020-01188-6 eng eng BMC BMC Pulmonary Medicine Høgli, Garcia, Svendsen, Skogen, Småbrekke. Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study. BMC Pulmonary Medicine. 2020;20(1):169 FRIDAID 1818210 doi:10.1186/s12890-020-01188-6 1471-2466 https://hdl.handle.net/10037/18777 openAccess Copyright 2020 The Author(s) VDP::Medical disciplines: 700 VDP::Medisinske Fag: 700 Journal article Tidsskriftartikkel Peer reviewed publishedVersion 2020 ftunivtroemsoe https://doi.org/10.1186/s12890-020-01188-6 2021-06-25T17:57:32Z Background - Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration. Methods - We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression. Results - We included 651 patients. Median age was 77 years [IQR; 64–84] and 46.5% were female. Median LOS was 4 days [IQR; 3–6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08–3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2–5] and 11.0 [IQR; 9.8–13] days. Conclusions - Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations. Article in Journal/Newspaper North Norway University of Tromsø: Munin Open Research Archive Norway BMC Pulmonary Medicine 20 1 |
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Open Polar |
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University of Tromsø: Munin Open Research Archive |
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ftunivtroemsoe |
language |
English |
topic |
VDP::Medical disciplines: 700 VDP::Medisinske Fag: 700 |
spellingShingle |
VDP::Medical disciplines: 700 VDP::Medisinske Fag: 700 Høgli, June Utnes Garcia, Beate Hennie Svendsen, Kristian Skogen, Vegard Småbrekke, Lars Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
topic_facet |
VDP::Medical disciplines: 700 VDP::Medisinske Fag: 700 |
description |
Background - Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration. Methods - We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression. Results - We included 651 patients. Median age was 77 years [IQR; 64–84] and 46.5% were female. Median LOS was 4 days [IQR; 3–6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08–3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2–5] and 11.0 [IQR; 9.8–13] days. Conclusions - Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations. |
format |
Article in Journal/Newspaper |
author |
Høgli, June Utnes Garcia, Beate Hennie Svendsen, Kristian Skogen, Vegard Småbrekke, Lars |
author_facet |
Høgli, June Utnes Garcia, Beate Hennie Svendsen, Kristian Skogen, Vegard Småbrekke, Lars |
author_sort |
Høgli, June Utnes |
title |
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
title_short |
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
title_full |
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
title_fullStr |
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
title_full_unstemmed |
Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study |
title_sort |
empirical prescribing of penicillin g/v reduces risk of readmission of hospitalized patients with community-acquired pneumonia in norway: a retrospective observational study |
publisher |
BMC |
publishDate |
2020 |
url |
https://hdl.handle.net/10037/18777 https://doi.org/10.1186/s12890-020-01188-6 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
North Norway |
genre_facet |
North Norway |
op_relation |
BMC Pulmonary Medicine Høgli, Garcia, Svendsen, Skogen, Småbrekke. Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study. BMC Pulmonary Medicine. 2020;20(1):169 FRIDAID 1818210 doi:10.1186/s12890-020-01188-6 1471-2466 https://hdl.handle.net/10037/18777 |
op_rights |
openAccess Copyright 2020 The Author(s) |
op_doi |
https://doi.org/10.1186/s12890-020-01188-6 |
container_title |
BMC Pulmonary Medicine |
container_volume |
20 |
container_issue |
1 |
_version_ |
1766140174938406912 |