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Article Abstract
Background: , a multidrug-resistant nosocomial pathogen, is associated with high mortality and therapeutic challenges due to resistance. Empiric Gram-negative antibiotic regimens often lack activity against , delaying effective therapy. This study evaluated timely versus delayed antibiotic therapy's impact on clinical outcomes in pneumonia patients.
Methods: This retrospective cohort study included adults hospitalized with pneumonia at the University of Kentucky HealthCare (2014-2023). Patients received active monotherapy or combination therapy with trimethoprim/sulfamethoxazole, minocycline, or levofloxacin. Timely therapy was defined as initiation ≤48 hours from index culture collection; delayed therapy as >48 hours. Propensity score matching minimized baseline differences. The Desirability of Outcome Ranking (DOOR) framework evaluated outcomes, prioritizing clinical efficacy and safety. Kaplan-Meier analysis assessed 30-day mortality. A Cox proportional hazards model with time-dependent covariates assessed therapy timing, adjusting for calendar year and COVID-19 time period.
Results: Of 430 patients (215 per group), DOOR analysis showed a 72.8% probability (95% CI, 67.9%-77.1%; < .001) that timely therapy resulted in patients being alive with fewer or no clinical events. Kaplan-Meier analysis confirmed higher survival with timely therapy (log-rank < .001), with a 22.8% absolute reduction in 30-day mortality (survival rates: 87.9% timely vs 65.1% delayed). A time-dependent Cox model, adjusted for calendar year and COVID-19 time period, confirmed timely therapy reduced death hazard (adjusted hazard ratio: 0.48; 95% CI: .27-.86; = .013).
Conclusions: Timely therapy significantly improved survival and clinical outcomes in pneumonia, highlighting the need for rapid, targeted treatment in managing resistant Gram-negative infections.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391758 | PMC |
| http://dx.doi.org/10.1093/ofid/ofaf469 | DOI Listing |
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