A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy
Abstract Background Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition. Methods We prospectively applied a therapeutic algorithm bas...
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| Veröffentlicht in: | Clinical infectious diseases 2019-03, Vol.68 (7), p.1080-1088 |
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| creator | Maruyama, Takaya Fujisawa, Takao Ishida, Tadashi Ito, Akihiro Oyamada, Yoshitaka Fujimoto, Kazuyuki Yoshida, Masamichi Maeda, Hikaru Miyashita, Naoyuki Nagai, Hideaki Imamura, Yoshifumi Shime, Nobuaki Suzuki, Shoji Amishima, Masaru Higa, Futoshi Kobayashi, Hiroyasu Suga, Shigeru Tsutsui, Kiyoyuki Kohno, Shigeru Brito, Veronica Niederman, Michael S. |
| description | Abstract
Background
Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition.
Methods
We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP).
Results
Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0–1 MDR risk (25.8% vs 5.3%, P < .001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0–1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P < .001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit |
| doi_str_mv | 10.1093/cid/ciy631 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2084915252</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>26621636</jstor_id><oup_id>10.1093/cid/ciy631</oup_id><sourcerecordid>26621636</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-7ce17e98697977228fb7d9b5d953a2dd49e7f01d7caa22f033b20d27ecacc85e3</originalsourceid><addsrcrecordid>eNp90MtLxDAQBvAgiruuXrwrvQgiVPNomuRYFl-w4ILruaTJVLv0ZZIe9r-30nWPHoaZw48P5kPokuB7ghV7MJUdZ5cycoTmhDMRp1yR4_HGXMaJZHKGzrzfYkyIxPwUzRjGMpEymSOSRZsvcLqHIVQmeg9OB_jcRWXnoqyuo3ULQ9O1lY7WOlTQBn-OTkpde7jY7wX6eHrcLF_i1dvz6zJbxSZJSIiFASJAyVQJJQSlsiyEVQW3ijNNrU0UiBITK4zWlJaYsYJiSwUYbYzkwBbodsrtXfc9gA95U3kDda1b6Aaf0_EFRTjldKR3EzWu895BmfeuarTb5QTnvxXlY0X5VNGIr_e5Q9GAPdC_TkZwM4Fu6P8Puprc1ofOHSRNU0pSlrIfef53jQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2084915252</pqid></control><display><type>article</type><title>A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Maruyama, Takaya ; Fujisawa, Takao ; Ishida, Tadashi ; Ito, Akihiro ; Oyamada, Yoshitaka ; Fujimoto, Kazuyuki ; Yoshida, Masamichi ; Maeda, Hikaru ; Miyashita, Naoyuki ; Nagai, Hideaki ; Imamura, Yoshifumi ; Shime, Nobuaki ; Suzuki, Shoji ; Amishima, Masaru ; Higa, Futoshi ; Kobayashi, Hiroyasu ; Suga, Shigeru ; Tsutsui, Kiyoyuki ; Kohno, Shigeru ; Brito, Veronica ; Niederman, Michael S.</creator><creatorcontrib>Maruyama, Takaya ; Fujisawa, Takao ; Ishida, Tadashi ; Ito, Akihiro ; Oyamada, Yoshitaka ; Fujimoto, Kazuyuki ; Yoshida, Masamichi ; Maeda, Hikaru ; Miyashita, Naoyuki ; Nagai, Hideaki ; Imamura, Yoshifumi ; Shime, Nobuaki ; Suzuki, Shoji ; Amishima, Masaru ; Higa, Futoshi ; Kobayashi, Hiroyasu ; Suga, Shigeru ; Tsutsui, Kiyoyuki ; Kohno, Shigeru ; Brito, Veronica ; Niederman, Michael S.</creatorcontrib><description>Abstract
Background
Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition.
Methods
We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP).
Results
Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0–1 MDR risk (25.8% vs 5.3%, P < .001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0–1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P < .001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit <30%, malnutrition, dehydration, and chronic liver disease), as well as hypotension and inappropriate therapy were significantly correlated with 30-day mortality, whereas the classification of pneumonia type (VAP, HAP, HCAP, CAP) was not.
Conclusions
Individual MDR risk factors can be used in a unified algorithm to guide and simplify empiric therapy for all pneumonia patients, and were more important than the classification of site of pneumonia acquisition in determining 30-day mortality.
Clinical Trials Registration
JMA-IIA00146.
We applied a single algorithm to all forms of pneumonia, which was followed in 82.5% of a cohort of 1089 patients. Only 4.3% received inappropriate therapy; in multivariate analysis, site of pneumonia acquisition was not predictive of 30-day mortality.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciy631</identifier><identifier>PMID: 30084884</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; ARTICLES AND COMMENTARIES ; Community-Acquired Infections - drug therapy ; Community-Acquired Infections - microbiology ; Cross Infection - drug therapy ; Cross Infection - microbiology ; Drug Resistance, Multiple, Bacterial ; Drug Therapy - methods ; Epidemiologic Methods ; Female ; Humans ; Male ; Middle Aged ; Pneumonia, Bacterial - drug therapy ; Pneumonia, Bacterial - microbiology ; Prospective Studies ; Risk Assessment ; Survival Analysis ; Treatment Outcome</subject><ispartof>Clinical infectious diseases, 2019-03, Vol.68 (7), p.1080-1088</ispartof><rights>The Author(s) 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-7ce17e98697977228fb7d9b5d953a2dd49e7f01d7caa22f033b20d27ecacc85e3</citedby><cites>FETCH-LOGICAL-c441t-7ce17e98697977228fb7d9b5d953a2dd49e7f01d7caa22f033b20d27ecacc85e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,1579,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30084884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Maruyama, Takaya</creatorcontrib><creatorcontrib>Fujisawa, Takao</creatorcontrib><creatorcontrib>Ishida, Tadashi</creatorcontrib><creatorcontrib>Ito, Akihiro</creatorcontrib><creatorcontrib>Oyamada, Yoshitaka</creatorcontrib><creatorcontrib>Fujimoto, Kazuyuki</creatorcontrib><creatorcontrib>Yoshida, Masamichi</creatorcontrib><creatorcontrib>Maeda, Hikaru</creatorcontrib><creatorcontrib>Miyashita, Naoyuki</creatorcontrib><creatorcontrib>Nagai, Hideaki</creatorcontrib><creatorcontrib>Imamura, Yoshifumi</creatorcontrib><creatorcontrib>Shime, Nobuaki</creatorcontrib><creatorcontrib>Suzuki, Shoji</creatorcontrib><creatorcontrib>Amishima, Masaru</creatorcontrib><creatorcontrib>Higa, Futoshi</creatorcontrib><creatorcontrib>Kobayashi, Hiroyasu</creatorcontrib><creatorcontrib>Suga, Shigeru</creatorcontrib><creatorcontrib>Tsutsui, Kiyoyuki</creatorcontrib><creatorcontrib>Kohno, Shigeru</creatorcontrib><creatorcontrib>Brito, Veronica</creatorcontrib><creatorcontrib>Niederman, Michael S.</creatorcontrib><title>A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition.
Methods
We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP).
Results
Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0–1 MDR risk (25.8% vs 5.3%, P < .001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0–1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P < .001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit <30%, malnutrition, dehydration, and chronic liver disease), as well as hypotension and inappropriate therapy were significantly correlated with 30-day mortality, whereas the classification of pneumonia type (VAP, HAP, HCAP, CAP) was not.
Conclusions
Individual MDR risk factors can be used in a unified algorithm to guide and simplify empiric therapy for all pneumonia patients, and were more important than the classification of site of pneumonia acquisition in determining 30-day mortality.
Clinical Trials Registration
JMA-IIA00146.
We applied a single algorithm to all forms of pneumonia, which was followed in 82.5% of a cohort of 1089 patients. Only 4.3% received inappropriate therapy; in multivariate analysis, site of pneumonia acquisition was not predictive of 30-day mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Community-Acquired Infections - drug therapy</subject><subject>Community-Acquired Infections - microbiology</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - microbiology</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Drug Therapy - methods</subject><subject>Epidemiologic Methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pneumonia, Bacterial - drug therapy</subject><subject>Pneumonia, Bacterial - microbiology</subject><subject>Prospective Studies</subject><subject>Risk Assessment</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90MtLxDAQBvAgiruuXrwrvQgiVPNomuRYFl-w4ILruaTJVLv0ZZIe9r-30nWPHoaZw48P5kPokuB7ghV7MJUdZ5cycoTmhDMRp1yR4_HGXMaJZHKGzrzfYkyIxPwUzRjGMpEymSOSRZsvcLqHIVQmeg9OB_jcRWXnoqyuo3ULQ9O1lY7WOlTQBn-OTkpde7jY7wX6eHrcLF_i1dvz6zJbxSZJSIiFASJAyVQJJQSlsiyEVQW3ijNNrU0UiBITK4zWlJaYsYJiSwUYbYzkwBbodsrtXfc9gA95U3kDda1b6Aaf0_EFRTjldKR3EzWu895BmfeuarTb5QTnvxXlY0X5VNGIr_e5Q9GAPdC_TkZwM4Fu6P8Puprc1ofOHSRNU0pSlrIfef53jQ</recordid><startdate>20190319</startdate><enddate>20190319</enddate><creator>Maruyama, Takaya</creator><creator>Fujisawa, Takao</creator><creator>Ishida, Tadashi</creator><creator>Ito, Akihiro</creator><creator>Oyamada, Yoshitaka</creator><creator>Fujimoto, Kazuyuki</creator><creator>Yoshida, Masamichi</creator><creator>Maeda, Hikaru</creator><creator>Miyashita, Naoyuki</creator><creator>Nagai, Hideaki</creator><creator>Imamura, Yoshifumi</creator><creator>Shime, Nobuaki</creator><creator>Suzuki, Shoji</creator><creator>Amishima, Masaru</creator><creator>Higa, Futoshi</creator><creator>Kobayashi, Hiroyasu</creator><creator>Suga, Shigeru</creator><creator>Tsutsui, Kiyoyuki</creator><creator>Kohno, Shigeru</creator><creator>Brito, Veronica</creator><creator>Niederman, Michael S.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190319</creationdate><title>A Therapeutic Strategy for All Pneumonia Patients</title><author>Maruyama, Takaya ; Fujisawa, Takao ; Ishida, Tadashi ; Ito, Akihiro ; Oyamada, Yoshitaka ; Fujimoto, Kazuyuki ; Yoshida, Masamichi ; Maeda, Hikaru ; Miyashita, Naoyuki ; Nagai, Hideaki ; Imamura, Yoshifumi ; Shime, Nobuaki ; Suzuki, Shoji ; Amishima, Masaru ; Higa, Futoshi ; Kobayashi, Hiroyasu ; Suga, Shigeru ; Tsutsui, Kiyoyuki ; Kohno, Shigeru ; Brito, Veronica ; Niederman, Michael S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-7ce17e98697977228fb7d9b5d953a2dd49e7f01d7caa22f033b20d27ecacc85e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Community-Acquired Infections - drug therapy</topic><topic>Community-Acquired Infections - microbiology</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - microbiology</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Drug Therapy - methods</topic><topic>Epidemiologic Methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pneumonia, Bacterial - drug therapy</topic><topic>Pneumonia, Bacterial - microbiology</topic><topic>Prospective Studies</topic><topic>Risk Assessment</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maruyama, Takaya</creatorcontrib><creatorcontrib>Fujisawa, Takao</creatorcontrib><creatorcontrib>Ishida, Tadashi</creatorcontrib><creatorcontrib>Ito, Akihiro</creatorcontrib><creatorcontrib>Oyamada, Yoshitaka</creatorcontrib><creatorcontrib>Fujimoto, Kazuyuki</creatorcontrib><creatorcontrib>Yoshida, Masamichi</creatorcontrib><creatorcontrib>Maeda, Hikaru</creatorcontrib><creatorcontrib>Miyashita, Naoyuki</creatorcontrib><creatorcontrib>Nagai, Hideaki</creatorcontrib><creatorcontrib>Imamura, Yoshifumi</creatorcontrib><creatorcontrib>Shime, Nobuaki</creatorcontrib><creatorcontrib>Suzuki, Shoji</creatorcontrib><creatorcontrib>Amishima, Masaru</creatorcontrib><creatorcontrib>Higa, Futoshi</creatorcontrib><creatorcontrib>Kobayashi, Hiroyasu</creatorcontrib><creatorcontrib>Suga, Shigeru</creatorcontrib><creatorcontrib>Tsutsui, Kiyoyuki</creatorcontrib><creatorcontrib>Kohno, Shigeru</creatorcontrib><creatorcontrib>Brito, Veronica</creatorcontrib><creatorcontrib>Niederman, Michael S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maruyama, Takaya</au><au>Fujisawa, Takao</au><au>Ishida, Tadashi</au><au>Ito, Akihiro</au><au>Oyamada, Yoshitaka</au><au>Fujimoto, Kazuyuki</au><au>Yoshida, Masamichi</au><au>Maeda, Hikaru</au><au>Miyashita, Naoyuki</au><au>Nagai, Hideaki</au><au>Imamura, Yoshifumi</au><au>Shime, Nobuaki</au><au>Suzuki, Shoji</au><au>Amishima, Masaru</au><au>Higa, Futoshi</au><au>Kobayashi, Hiroyasu</au><au>Suga, Shigeru</au><au>Tsutsui, Kiyoyuki</au><au>Kohno, Shigeru</au><au>Brito, Veronica</au><au>Niederman, Michael S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2019-03-19</date><risdate>2019</risdate><volume>68</volume><issue>7</issue><spage>1080</spage><epage>1088</epage><pages>1080-1088</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Empiric therapy of pneumonia is currently based on the site of acquisition (community or hospital), but could be chosen, based on risk factors for multidrug-resistant (MDR) pathogens, independent of site of acquisition.
Methods
We prospectively applied a therapeutic algorithm based on MDR risks, in a multicenter cohort study of 1089 patients with 656 community-acquired pneumonia (CAP), 238 healthcare-associated pneumonia (HCAP), 140 hospital-acquired pneumonia (HAP), or 55 ventilator-associated pneumonia (VAP).
Results
Approximately 83% of patients were treated according to the algorithm, with 4.3% receiving inappropriate therapy. The frequency of MDR pathogens varied, respectively, with VAP (50.9%), HAP (27.9%), HCAP (10.9%), and CAP (5.2%). Those with ≥2 MDR risks had MDR pathogens more often than those with 0–1 MDR risk (25.8% vs 5.3%, P < .001). The 30-day mortality rates were as follows: VAP (18.2%), HAP (13.6%), HCAP (6.7%), and CAP (4.7%), and were lower in patients with 0–1 MDR risks than in those with ≥2 MDR risks (4.5% vs 12.5%, P < .001). In multivariate logistic regression analysis, 5 risk factors (advanced age, hematocrit <30%, malnutrition, dehydration, and chronic liver disease), as well as hypotension and inappropriate therapy were significantly correlated with 30-day mortality, whereas the classification of pneumonia type (VAP, HAP, HCAP, CAP) was not.
Conclusions
Individual MDR risk factors can be used in a unified algorithm to guide and simplify empiric therapy for all pneumonia patients, and were more important than the classification of site of pneumonia acquisition in determining 30-day mortality.
Clinical Trials Registration
JMA-IIA00146.
We applied a single algorithm to all forms of pneumonia, which was followed in 82.5% of a cohort of 1089 patients. Only 4.3% received inappropriate therapy; in multivariate analysis, site of pneumonia acquisition was not predictive of 30-day mortality.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>30084884</pmid><doi>10.1093/cid/ciy631</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1058-4838 |
| ispartof | Clinical infectious diseases, 2019-03, Vol.68 (7), p.1080-1088 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2084915252 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use ARTICLES AND COMMENTARIES Community-Acquired Infections - drug therapy Community-Acquired Infections - microbiology Cross Infection - drug therapy Cross Infection - microbiology Drug Resistance, Multiple, Bacterial Drug Therapy - methods Epidemiologic Methods Female Humans Male Middle Aged Pneumonia, Bacterial - drug therapy Pneumonia, Bacterial - microbiology Prospective Studies Risk Assessment Survival Analysis Treatment Outcome |
| title | A Therapeutic Strategy for All Pneumonia Patients: A 3-Year Prospective Multicenter Cohort Study Using Risk Factors for Multidrug-resistant Pathogens to Select Initial Empiric Therapy |
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