Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia

Lee, Mi Suk; Oh, Jee Youn; Kang, Cheol-In; Kim, Eu Suk; Park, Sunghoon; Rhee, Chin Kook; Jung, Ji Ye; Jo, Kyung-Wook; Heo, Eun Young; Park, Dong-Ah; Suh, Gee Young; Kiem, Sungmin

If patient does not require treatment for underlying diseases, and does not require diagnostic tests, and a social environment in which the patient can be taken care of is established, discharge may be considered [136, 157, 161] (Table 11) . However, a discharge decision cannot be made solely based on objective criteria. Ultimately, the clinician in charge must make the decision after considering the patient's clinical and social situations. There is a controversy regarding whether or not a patient must satisfy all conditions of clinical stability in the PSI before discharge. However, the more conditions the patient does not satisfy, the more likely he/she is likely to have poor prognoses [162, 163] . According to a prospective study that monitored 680 inpatients with pneumonia, the rate of mortality or readmission was 10.5% when a patient satisfied all conditions of clinical stability shown in Table 9 in the last 24 hours before discharge, but it increased to 13.7% with the odds ratio at 1.6 when the patient did not meet one of the conditions, and to 46.2% with the odds ratio at 5.4 if the patient did not satisfy two or more conditions [162] . A recently published prospective study has also reported that as the number of unsatisfied conditions increases, the 30-day mortality rate increases, and that fever is the most highly associated with prognosis [163] .