Effects of age, comorbidity and adherence to current antimicrobial guidelines on mortality in hospitalized elderly patients with community-acquired pneumonia

Table 2 Application of 2016 Chinese CAP guideline in hospitalized patients over 65 years without risk factors of Pseudomonas aeruginosa infection (n = 2258)

Regimen	General ward inpatients (n = 2090)	ICU patients (n = 168)
Consistent with guideline	795(38.0)	1(0.6)
β-lactam	415(19.8)	0(0)
Fluoroquinolone	312(14.9)	0(0)
β-lactam + macrolide	68(3.3)	0(0)
β-lactam + fluoroquinolone	0(0)	1(0.6)
Undertreated by guideline	201(9.6)	120(71.4)
β-lactam	153(7.3) ^a	92(54.8)^b
β-lactam + macrolide	21(1.0)^a	1(0.6)
Macrolide	15(0.7)	0(0)
Fluoroquinolone +/− β-lactam^c	0(0)	26(15.5)
Other combination	12(0.6)	1(0.6)
Overtreated by guideline	1094(52.3)	47(28.0)
Antipseudomonal β-lactam^d	530(25.4)^#	0(0)
Fluoroquinolone +β-lactam/ other^e	451(21.6) ^##	37(22.0)^*
Antipseudomonal β-lactam^d + macrolide	46(2.2) ^###	5(3.0)^**
Antipseudomonal β-lactam^d + other^e	39(1.9) ^####	2(1.2) ^***
Fluoroquinolone + macrolide	12(0.6)	0(0)
β-lactam +quinolone+ other^e	8(0.3)	3(1.8) ^****
β-lactam +macrolide+ fluoroquinolone /other^e	8(0.3)	0(0)

Data on empirical antimicrobial regimens in 37 patients were missing. Three patients in the general ward who were administered antifungal agents, and 6 patients in the ICU who were administered antipseudomonal β-lactam plus antifungal agents were ruled out
β-lactam^a = penicillin, first / second generation cephalosporins
β-lactam^b = second/ third generation cephalosporins (n = 5), cephamycins (n = 12) and antipseudomonal β-lactam (n = 75, including carbapenem 25)
β-lactam^c = second generation cephalosporins (n = 6) and cephamycins (n = 7)
Antipseudomonal β-lactam^d = piperacillin/tazobactam, ticarcillin/clavulanic acid, mezlocillin/sulbactam, cefoperazone/sulbactam, ceftazidime, cefoperazone, cefepime, carbapenem (imipenem / cilastatin and meropenem)
other^e = imidazoles, tetracyclines, aminoglycoside, lincomycin, fosfomycin and glycopeptides
^# carbapenem = 108
^## Antipseudomonal β-lactam = 260 (carbapenem = 36), other β-lactam = 182, other^e = 9
^### carbapenem = 11
^#### carbapenem+glycopeptide =6, carbapenem+other =6, other antipseudomonal β-lactam+other =27
* Antipseudomonal β-lactam = 36 (carbapenem = 10); ** carbapenem = 2
*** carbapenem+glycopeptide = 2; **** carbapenem = 2

ISSN: 1471-2334