Impact of guideline-consistent therapy on outcome of XXXX with healthcare-associated and @entity497 .

@entity1 @entity497 @entity55
BACKGROUND: A new category of @entity55 ( @entity55 ) has been added in the most recent American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines, since multidrug-resistant (MDR) pathogens are more common in @entity1 with @entity55 than in those with @entity497 ( @entity497 ). The optimal empirical management of @entity1 with @entity55 remains controversial and adherence to guidelines is inconsistent. METHODS: A retrospective cohort study of 3295 adults admitted for @entity55 in an academic centre of Canada, between 1997 and 2008. RESULTS: MDR pathogens were more common among @entity1 with @entity55 than in those with @entity497 , but less so than in other studies. Compared with @entity1 with @entity497 , those with @entity55 had a higher all-cause 30 day mortality [68/563 (12%) versus 201/2732 (7%); P < 0.001] and more frequent need for mechanical ventilation [78/563 (14%) versus 276/2732 (10%); P = 0.01]. In @entity1 with @entity497 , mortality was lower when treatment was concordant with guidelines [86/1557 (6%) versus 109/1097 (10%) if discordant; adjusted odds ratio 0.6 (0.4-0.8); P < 0.001]. In @entity55 , mortality was similar whether or not empirical treatment was concordant with guidelines [6/35 (17%) versus 18/148 (12%) if discordant; P = 0.4]. However, 30 day mortality tended to be higher when the empirical treatment was microbiologically ineffective [4/22 (18%) versus 17/187 (9%) when effective; P = 0.3]. CONCLUSIONS: @entity55 is associated with worse outcomes than @entity497 . MDR pathogens were implicated in only a small fraction of @entity55 cases. In our study, unlike @entity497 , non-respect of current @entity55 guidelines had no adverse effect on the ultimate outcome. Strategies for the empirical management of @entity55 should be tailored to the local epidemiological context.
