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Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH

Francesco Blasi1*, Javier Garau2, Jesús Medina3, Marco Ávila4, Kyle McBride5, Helmut Ostermann6 and on behalf of the REACH study group

Author Affiliations

1 Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

2 Department of Medicine, Hospital Universitari Mutua de Terrassa, Plaza Doctor Robert 5, Terrassa, Barcelona, 08221, Spain

3 Medical Evidence Centre (Global Medical Affairs), AstraZeneca, Parque Norte, Edificio Roble, Serrano Galvache 56, Madrid, 28033, Spain

4 AstraZeneca EMEA, Level 7, 2 Kingdom Street, London, W2 6BD, UK

5 Instat Services, Inc., 1 Wilson Street, Chatham, NJ, 07928, USA

6 Department of Internal Medicine III, Haematology and Oncology, University Hospital Munich, Munich, Germany

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Respiratory Research 2013, 14:44  doi:10.1186/1465-9921-14-44

Published: 15 April 2013

Abstract

Background

Data describing real-life management and treatment of community-acquired pneumonia (CAP) in Europe are limited. REACH (http://NCT01293435 webcite) was a retrospective, observational study collecting data on the management of EU patients hospitalized with CAP.

The purpose of this study was to understand patient and disease characteristics in patients hospitalized with CAP and to review current clinical practices and outcomes.

Methods

Patients were aged ≥18 years, hospitalized with CAP between March 2010 and February 2011, and requiring in-hospital treatment with intravenous antibiotics. An electronic Case Report Form was used to collect patient, disease and treatment variables, including type of CAP, medical history, treatment setting, antibiotics administered and clinical outcomes.

Results

Patients (N = 2,039) were recruited from 128 centres in ten EU countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Turkey, UK). The majority of patients were aged ≥65 years (56.4%) and had CAP only (78.8%). Initial antibiotic treatment modification occurred in 28.9% of patients and was more likely in certain groups (patients with comorbidities; more severely ill patients; patients with healthcare-associated pneumonia, immunosuppression or recurrent episodes of CAP). Streamlining (de-escalation) of therapy occurred in 5.1% of patients. Mean length of hospital stay was 12.6 days and overall mortality was 7.2%.

Conclusion

These data provide a current overview of clinical practice in patients with CAP in EU hospitals, revealing high rates of initial antibiotic treatment modification. The findings may precipitate reassessment of optimal management regimens for hospitalized CAP patients.

Keywords:
Antibacterial agents; Clinical management; Community-acquired pneumonia; Retrospective studies