Current management of patients hospitalized with community-acquired pneumonia across Europe (2010-2011) : assessment of clinical practice patterns and real-life effectiveness of antibiotics (reach study)

Introduction: Data describing real-life management and treatment of community-acquired pneumonia (CAP) in Europe are limited. The REtrospective Study to Assess the Clinical Management of Patients With Moderate-to-severe cSSTI or CAP Infections in the Hospital Setting (REACH) (NCT01293435) was an observational retrospective study that collected data on the management of European patients hospitalized with CAP in order to review current clinical practices and outcomes related to initial treatment failure, and to assess intercountry differences. Methods: Patients were aged ≥18 years, hospitalized with CAP between March 2010 and February 2011, and required in-hospital management and treatment with intravenous antibiotics. An electronic Case Report Form was used to collect a number of patient, disease and treatment variables, including type of CAP, medical history, treatment setting, antibiotic treatments and clinical outcomes, particularly treatment failure. Results: Patients (N=2039) were recruited from 128 centres across ten European countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Turkey, UK). The majority were aged ≥65 years (n=1150; 56.4%) (mean age 64.5 years [median: 68; range: 18–104] and had CAP only (n=1607; 78.8%). Healthcare-associated pneumonia (HCAP) was identified in 245 patients (12.0%) and 72 (3.5%) were immunocompromised. Co-morbidities were present in 1598 patients (78.4%) and 1143 (56.1%) had received medications in the 3 months prior to hospitalization (antibiotics or antivirals: 395 [19.4%]). Patient populations in university versus non-university hospitals did not differ markedly in severity of illness (mean Pneumonia Outcomes Research Team/Pneumonia Severity Index [PORT/PSI] score: 3.5 [n=290] vs 3.1 [n=64]; mean CURB-65 score: 2.3 [n=374] vs 2.0 [n=153]). Antibiotics were administered to the majority of patients on Day 1 of hospitalization, empirically in 94.1% of patients. Treatment failure, defined as a need for antibiotic change, increased with more severe CAP (PORT/PSI score IV–V and CURB-65 score 3–5). First-choice treatment was more likely to fail in immunocompromised patients, patients with co-morbidities or recurrent infection, and patients with HCAP. The clinical outcomes for patients with CAP of varying severity or with co-morbidities are shown in Table 1. Conclusions: These data provide a reliable and current overview of the clinical management of CAP in European hospitals in 2010–2011 and highlight that treatment failure with antibiotic therapy is common, particularly in certain patient groups (with co-morbidities, more severely ill patients, patients with HCAP, immunosuppressed patients, re-hospitalized). These results are likely to provide the foundations for reassessment of optimal management regimens for hospitalized CAP patients.