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June 24, 1998

Quality of Care for Elderly Patients With Pneumonia—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(24):1950-1952. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-24-jac80011

In Reply.— Drs Bakker and Rommes note that we did not report the association between antibiotic treatment prior to hospitalization and mortality. Unadjusted 30-day mortality rates were considerably higher (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.14-1.40) in patients who received antibiotics before hospital admission (17.6%, n=3728) compared with patients who did not (14.4%, n=10341). In multivariable analyses that adjusted for patients' demographic factors, comorbid illnesses, physical examination findings, and laboratory and radiographic findings, prior antibiotic use was independently associated with 30-day mortality (OR, 1.23; 95% CI, 1.23-1.37). Although these findings may seem counterintuitive, it is possible that patients who received antibiotics prior to hospitalization may have been sicker and that our risk-adjustment method may not have fully accounted for differences in mortality risk.

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