{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:28:39Z","timestamp":1755793719755,"version":"3.44.0"},"reference-count":0,"publisher":"SMW Supporting Association","issue":"3738","license":[{"start":{"date-parts":[[2013,9,8]],"date-time":"2013-09-08T00:00:00Z","timestamp":1378598400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Swiss Med Wkly"],"abstract":"<jats:p>BACKGROUND:  Although most experts recommend empirical antibiotic treatment, covering also atypical bacteria, for patients admitted  to an intensive care unit (ICU), the data are not clear for patients admitted  to a general ward. European guidelines recommend starting empirical treatment  with a beta-lactam antibiotic with or without a macrolide, but the with\/without  is not clarified. We investigated whether the use of antibiotic coverage for atypical  pathogens was guided by clinical parameters.\n        METHODS:  We retrospectively analysed 300 patients hospitalised with community-acquired  pneumonia. Four parameters for possible atypical pneumonia (age &lt;55 years,  abdominal symptoms, sodium &lt;130 mmol\/l, immunosuppression) and three for  pneumonia severity (pneumonia severity index [PSI], ICU admission, pO2&lt;8  kPa (60 mm Hg) or O2saturation &lt;90%) were defined and correlated  with the probability of coverage for atypical pathogens. Correlations were  calculated using the chi-square test for 2 x 2 tables.\n        RESULTS:  Patients younger than 55 years significantly more likely to receive coverage  for atypical pathogens than older patients (odds ratio [OR] 2.68;  95% confidence interval [CI] 1.3\u20135.5, p = 0.009). In patients with a PSI &gt;III the proportion  receiving coverage for atypical bacteria was even smaller than in patients with  less severe pneumonia (OR 0.77; 95% CI 0.60\u20130.99, p = 0.03), but no difference was  found for PSI &gt;IV compared with PSI \u2264IV (OR = 1.03; 95% CI 0.61\u20131.74,  p = 0.9). The other  clinical parameters had no effect on antibiotic coverage: ICU admission (OR =1.39;  95% CI 0.87\u20132.4, p = 0.15);  pO2&gt;8 kPa or O2-Saturation &gt;90% (OR 1.36;  95% CI 0.85\u20132.17, p = 0.19); abdominal symptoms (OR 1.06; 95% CI 0.51\u20132.25, p = 0.88); sodium &lt;130 mmol\/l (OR 0.63;  95% CI 0.29\u20131.36, p = 0.2)  or immunosuppression (OR 1.007; 95% CI 0.462\u201344, p = 1). There was also no correlation  between the number of clinical parameters present and the coverage of atypical  pathogens (r = 0.48). Mortality was no different between patients in whom  atypical pathogens were covered compared with those with beta-lactam therapy  alone (OR 1.2; 95% CI 0.66\u20132.25, p = 0.43).\n        CONCLUSION:  Physicians have difficulties deciding when to cover atypical pathogens in  hospitalised patients with community-acquired pneumonia. Guidelines should  clarify under what circumstances combination therapy is warranted.<\/jats:p>","DOI":"10.4414\/smw.2013.13870","type":"journal-article","created":{"date-parts":[[2014,7,3]],"date-time":"2014-07-03T10:27:23Z","timestamp":1404383243000},"page":"w13870","source":"Crossref","is-referenced-by-count":2,"title":["Coverage  of atypical pathogens for hospitalised patients with\u00a0community-acquired  pneumonia is not guided by clinical parameters"],"prefix":"10.57187","volume":"143","author":[{"given":"Rein Jan","family":"Piso","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Bassetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36756","published-online":{"date-parts":[[2013,9,8]]},"container-title":["Swiss Medical Weekly"],"original-title":[],"link":[{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1752\/2386","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1752\/2387","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/download\/1752\/2386","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T04:57:11Z","timestamp":1755233831000},"score":1,"resource":{"primary":{"URL":"https:\/\/smw.ch\/index.php\/smw\/article\/view\/1752"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,8]]},"references-count":0,"journal-issue":{"issue":"3738","published-online":{"date-parts":[[2013,9,9]]}},"URL":"https:\/\/doi.org\/10.4414\/smw.2013.13870","relation":{},"ISSN":["1424-3997"],"issn-type":[{"type":"electronic","value":"1424-3997"}],"subject":[],"published":{"date-parts":[[2013,9,8]]}}}