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Reducing Readmissions in Community-Acquired Pneumonia

Reducing Readmissions in Community-Acquired Pneumonia

In the United States, community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality due to infection and most often strikes the elderly and individuals with comorbidities. The 30-day mortality rate for Medicare patients admitted to the hospital for CAP is about 12% and has not changed significantly in decades (Table 1). CAP has been shown to increase long-term mortality to as high as 40% within 1 year of admission. The infection is one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge. Estimates show that the cost of treating CAP exceeds $17 billion per year. Hospitalizing Patients With Community-Acquired Pneumonia “The decision on whether or not hospitalization is necessary for CAP is critical because there are multiple consequences,” says Thomas M. File, Jr., MD, MSc. “Hospitalizations can influence the cost of care, the intensity of diagnostic testing, and the selection of antimicrobial agents.” There are several advantages to outpatient treatment of CAP—when used appropriately—including cost, patient preference, faster convalescence, and fewer nosocomial complications. Hospitalization decisions should be based on several factors, including (among others): age over 50; significant underlying coexisting conditions; elevated blood urea nitrogen levels; and the presence of altered mental status or significant abnormalities in vital signs. “Readmission for CAP patients recently discharged after hospitalization represents an important, expensive, and often preventable adverse outcome,” Dr. File says. “The risk of readmission can be modified by the quality and type of care that is provided. Improving CAP readmission rates is the joint responsibility of hospitals and clinicians.” He adds that measuring readmission rates can help...
Predicting Death From Pneumonia

Predicting Death From Pneumonia

Community-acquired pneumonia (CAP) remains a frequent cause of morbidity and mortality and ranks as the top cause of death from an infectious disease in the world as well as the third leading cause of death overall. In addition to dying within the hospital, patients hospitalized with pneumonia are at an increased risk of death for months to years after being discharged. Over the past decade, significant efforts have been made to improve the care and outcomes associated with CAP. These efforts, however, are often complicated by the fact that about half of all CAP-associated mortality is not directly due to the infection. Cardiovascular complications and death from other comorbidities cause a substantial proportion of CAP-associated mortality. Recently, 30-day mortality for patients with pneumonia became a publicly reported performance measure by CMS. Hospitals are now being measured based on how their CAP patients fare after they are discharged. “In addition to patient-related factors, 30-day mortality can be affected by the quality of care provided in hospitals and after discharge,” says Mark L. Metersky, MD, FCCP. “Although risk factors for mortality in patients with CAP have been investigated extensively, relatively few studies have compared patient-specific factors for mortality before and after discharge from the hospital.” Predicting Mortality in Pneumonia Patients In a retrospective analysis in the August 2012 issue of Chest, Dr. Metersky and colleagues reviewed 21,223 Medicare patients with CAP who were admitted to the hospital. They investigated whether or not patient characteristics can help distinguish those who are at risk for mortality before they were discharged compared with after they were discharged. “This knowledge may help physicians and hospitals...
Assessing Options for Pneumonia Hospitalizations

Assessing Options for Pneumonia Hospitalizations

Community-acquired pneumonia (CAP) affects approximately 4 million patients in the United States each year. Around 20% of these patients are admitted to hospitals for treatment. In patients requiring inpatient treatment, overall mortality is approximately 12%. However, it can be much higher in CAP patients requiring admission to the ICU. When parenteral antimicrobials are required for the treatment of hospitalized patients, the mainstay of therapy for many years has included either a combination of a β-lactam antibiotic with a macrolide antibiotic, or the use of a respiratory fluoroquinolone alone. β-lactam antibiotics do not have antibacterial activity against the so-called “atypical bacteria,” including species of Mycoplasma, Chlamydia, andLegionella, which are important pathogens in CAP. Classes of antibiotics active against these atypical pathogens include macrolides, fluoroquinolones, and tetracyclines. Urgent Need of New Antimicrobial Agents Two important realities are beginning to impact the traditional recommendations for antimicrobial therapy in CAP. First, there is an urgent need for the development of new antimicrobial agents that are more active against resistant bacterial pathogens. Second, the rapid development of antimicrobial-resistant bacterial pathogens has compromised many of our existing antimicrobials. “Antimicrobial resistance continues to increase in a dramatic fashion.” While there are many reasons for the slowing of new antimicrobial discoveries and the rapid development of antimicrobial resistance, the major factors appear to be overuse and misuse of antibiotics in both man and animals and the inability of the pharmaceutical industry to realize significant financial return on investment from new antimicrobial development. This lack of new agents has been called one of the three greatest threats to human health by the Infectious Diseases Society of America (IDSA). Yet, antimicrobial...
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