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Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults

Overview of attention for article published in Cochrane database of systematic reviews, August 2015
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (89th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (63rd percentile)

Mentioned by

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19 tweeters
facebook
1 Facebook page
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2 Wikipedia pages

Citations

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56 Dimensions

Readers on

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194 Mendeley
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Title
Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults
Published in
Cochrane database of systematic reviews, August 2015
DOI 10.1002/14651858.cd007577.pub3
Pubmed ID
Authors

Richard Pugh, Chris Grant, Richard PD Cooke, Ged Dempsey

Abstract

Pneumonia is the most common hospital-acquired infection affecting patients in the intensive care unit (ICU). However, current national guidelines for the treatment of hospital-acquired pneumonia (HAP) are several years old and the diagnosis of pneumonia in mechanically ventilated patients (VAP) has been subject to considerable recent attention. The optimal duration of antibiotic therapy for HAP in the critically ill is uncertain. To assess the effectiveness of short versus prolonged-course antibiotics for HAP in critically ill adults, including patients with VAP. We searched CENTRAL (2015, Issue 5), MEDLINE (1946 to June 2015), MEDLINE in-process and other non-indexed citations (5 June 2015), EMBASE (2010 to June 2015), LILACS (1982 to June 2015) and Web of Science (1955 to June 2015). We considered all randomised controlled trials (RCTs) comparing a fixed 'short' duration of antibiotic therapy with a 'prolonged' course for HAP (including patients with VAP) in critically ill adults. Two review authors conducted data extraction and assessment of risk of bias. We contacted trial authors for additional information. We identified six relevant studies involving 1088 participants. This included two new studies published after the date of our previous review (2011). There was substantial variation in participants, in the diagnostic criteria used to define an episode of pneumonia, in the interventions and in the reported outcomes. We found no evidence relating to patients with a high probability of HAP who were not mechanically ventilated. For patients with VAP, overall a short seven- or eight-day course of antibiotics compared with a prolonged 10- to 15-day course increased 28-day antibiotic-free days (two studies; N = 431; mean difference (MD) 4.02 days; 95% confidence interval (CI) 2.26 to 5.78) and reduced recurrence of VAP due to multi-resistant organisms (one study; N = 110; odds ratio (OR) 0.44; 95% CI 0.21 to 0.95), without adversely affecting mortality and other recurrence outcomes. However, for cases of VAP specifically due to non-fermenting Gram-negative bacilli (NF-GNB), recurrence was greater after short-course therapy (two studies, N = 176; OR 2.18; 95% CI 1.14 to 4.16), though mortality outcomes were not significantly different. One study found that a three-day course of antibiotic therapy for patients with suspected HAP but a low Clinical Pulmonary Infection Score (CPIS) was associated with a significantly lower risk of superinfection or emergence of antimicrobial resistance, compared with standard (prolonged) course therapy. On the basis of a small number of studies and appreciating the lack of uniform definition of pneumonia, we conclude that for patients with VAP not due to NF-GNB a short, fixed course (seven or eight days) of antibiotic therapy appears not to increase the risk of adverse clinical outcomes, and may reduce the emergence of resistant organisms, compared with a prolonged course (10 to 15 days). However, for patients with VAP due to NF-GNB, there appears to be a higher risk of recurrence following short-course therapy. These findings do not differ from those of our previous review and are broadly consistent with current guidelines. There are few data from RCTs comparing durations of therapy in non-ventilated patients with HAP, but on the basis of a single study, short-course (three-day) therapy for HAP appears not to be associated with worse clinical outcome, and may reduce the risk of subsequent infection or the emergence of resistant organisms when there is low probability of pneumonia according to the CPIS.

Twitter Demographics

The data shown below were collected from the profiles of 19 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 194 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 <1%
Indonesia 1 <1%
Portugal 1 <1%
France 1 <1%
Chile 1 <1%
Mexico 1 <1%
Brazil 1 <1%
Japan 1 <1%
United States 1 <1%
Other 2 1%
Unknown 183 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 31 16%
Student > Master 26 13%
Unspecified 24 12%
Student > Bachelor 23 12%
Other 20 10%
Other 70 36%
Readers by discipline Count As %
Medicine and Dentistry 117 60%
Unspecified 30 15%
Pharmacology, Toxicology and Pharmaceutical Science 12 6%
Agricultural and Biological Sciences 10 5%
Nursing and Health Professions 7 4%
Other 18 9%

Attention Score in Context

This research output has an Altmetric Attention Score of 15. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 10 May 2019.
All research outputs
#999,063
of 12,959,994 outputs
Outputs from Cochrane database of systematic reviews
#3,147
of 10,419 outputs
Outputs of similar age
#24,592
of 238,024 outputs
Outputs of similar age from Cochrane database of systematic reviews
#99
of 270 outputs
Altmetric has tracked 12,959,994 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 10,419 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.5. This one has gotten more attention than average, scoring higher than 69% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 238,024 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 89% of its contemporaries.
We're also able to compare this research output to 270 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 63% of its contemporaries.