Mandell et al reported risk factors for nonresponse to antibiotic therapy for an adult with community-acquired pneumonia. This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in the United States, Canada and Spain.
Patient selection: adult with community-acquired pneumonia (CAP)
Risk factors for early therapeutic failure:
(1) multilobar infiltrate (OR 1.8)
(2) PSI class (OR 2.8), with greater risk for Classes IV and V
(3) Legionalla pneumonia (OR 2.7)
(4) Gram negative pneumonia (OR 4.3)
(5) discordant therapy (OR 2.5)
Factors associated with lower risk of therapeutic failure:
(1) age > 65 years (OR 0.4)
(2) concordant therapy (OR 0.6)
Risk factors for overall failure:
(1) liver disease (OR 2.0)
(2) pleural effusion (OR 2.7)
(3) multilobar infiltrated (OR 2.1)
(4) cavitation (OR 4.1)
(5) leukopenia (OR 3.7)
Factors associated with a lower overall risk:
(1) COPD (OR 0.6)
(2) vaccination to the causative organism (OR 0.3; primarily Streptococcus pneumoniae)
(3) fluoroquinolone therapy (OR 0.5)
Note: There are other factors to consider such as noncompliance and counterfeit medication. These are less likely in a hospitalized patient. There are also conditions such as pulmonary embolism that may mimic a pneumonia. Also, fungi and viruses would not respond to antibacterial agents.
