Delayed time to
antibiotic administration has been linked with higher mortality for patients with community-acquired
pneumonia, but the impact of antibiotic resistance on clinical outcomes has been controversial. In the current study we assess the combined impact of antibiotic resistance and
antibiotic timing on outcomes, including inhospital mortality, complications,
length of stay, and time to stability, for patients hospitalized with community-acquired bacteremic
pneumococcal pneumonia. We conducted a retrospective cohort study in 43 hospitals in the Southeastern Pennsylvania region from 2001 to 2004. Eligible adult patients had pneumococcal
bacteremia and radiographic evidence of
pneumonia. Outcomes were assessed based on medical record review. Multivariable regression was used to adjust for severity of illness and sequentially assess the impact of antibiotic resistance and time to active
antibiotic therapy. The overall inhospital mortality was 10%. Overall, levels of
macrolide,
cephalosporin, and
fluoroquinolone resistance were low and did not adversely impact the time to administration of active
antibiotic therapy. Receipt of at least 1 active
antibiotic within 4 hours was associated with reduced mortality (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.2-1.0) and shortened
length of stay (OR, 0.77; CI, 0.6-1.0) but did not reduce the risk of other adverse outcomes. We conclude that early
antibiotic administration reduces the risks of mortality in patients with bacteremic
pneumococcal pneumonia. Current patterns of drug resistance did not lead to delays in administration of active antimicrobial
therapy.