Delayed Antibiotic Treatment in Community-acquired Pneumococcal Pneumonia.
Delayed Antibiotic Treatment in Community-acquired Pneumococcal Pneumonia.
I. To investigate time measurement from emergency room admission to first antibiotic
 administration.

 II. To evaluate risk factors for prolonged time to first antibiotic administration.

 III. To correlate time measurement with Charlson comorbidity index and multimorbidity
 patterns.

 IV. To investigate the impact of a delayed time to first antibiotic administration on the
 outcome
In this retrospective cohort study, we plan to include all patients presenting with a
 community-acquired pneumococcal pneumonia at the University Hospital of Zurich between
 January 1, 2006 and June 30, 2012 (6½ years). The patients will be identified either with one
 or more blood culture pairs positive for S. pneumoniae or with a positive pneumococcal urine
 antigen assay in combination with the clinical diagnosis of CAP, which was based on the
 presence of select clinical features (e.g., cough, fever, sputum production, and pleuritic
 chest pain) and is supported by imaging of the lung, usually by chest radiography according
 to Infectious Diseases Society of America/American Thoracic Society consensus guidelines on
 the management of CAP in adults [11].

 CAP is not considered if the patient is discharged from a hospital less than 7 days before
 the current hospital admission, if the first blood culture or urinary antigen assay is
 obtained more than 1 week after hospital admission, or if the patient has no clinical
 diagnosis of CAP at the time of admission. Patients referred from or transferred to another
 hospital are excluded.

 After identification of eligible patients upon microbiological results, medical records are
 reviewed using a standardized data collection questionnaire. Comorbidity is determined using
 the Charlson comorbidity index [10]. Additionally, all patients are classified according to
 the multimorbidity patterns proposed by Holden et al. [12]. These are:

 1. arthritis, osteoporosis, other chronic pain, bladder problems, and irritable bowel;

 2. asthma, chronic obstructive pulmonary disease, and allergies;

 3. back/neck pain, migraine, other chronic pain, and arthritis;

 4. high blood pressure, high cholesterol, obesity, diabetes, and fatigue;

 5. cardiovascular disease, diabetes, fatigue, high blood pressure, high cholesterol, and
 arthritis; and

 6. irritable bowel, ulcer, heartburn, and other chronic pain.

 Time calculation is based upon the moment of emergency room (ER) admission.
Inclusion criteria: Patients with community-acquired pneumococcal pneumonia, which was
 confirmed by

 1. detection of Streptococcus pneumoniae in blood cultures, tracheal secretion or sputum
 OR/AND

 2. positive urinary pneumococcal antigen AND

 3. presence of cough and presence of one of the following signs/symptoms: new focal chest
 signs; dyspnoea; tachypnoea; fever AND

 4. radiologic signs of pneumonia

 Exclusion criteria: - Pneumonia of other cause (e.g. non-pneumococcal pneumonia)

 -  Hospital-acquired or ventilator-associated pneumonia

 -  Patients referred from or transferred to another hospital