Influence of deviation from guidelines on the outcome of community-acquired pneumonia.
OBJECTIVE
s: Consensus guidelines for the empirical treatment of community-acquired pneumonia (CAP) have been published. We investigated the following factors: (1) the degree of adherence to American Thoracic Society (ATS) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) guidelines; and (2) the influence of adhering to these guidelines on mortality and length of hospitalization.


METHODS
Prospective, observational study.


METHODS
Tertiary-care teaching hospital.


METHODS
Two hundred ninety-five patients with CAP who were consecutively admitted to the hospital and treated empirically.


METHODS
Patients were stratified according to the prognostic rule of Fine, and the antibiotic regimen prescribed in the first 24 h was evaluated as to whether or not it adhered to treatment guidelines.


RESULTS
Adherence to SEPAR and ATS guidelines was 66% and 88%, respectively. There were no significant differences in mortality or duration of hospitalization between adherent and nonadherent regimens. However, mortality in severe CAP (Fine risk class V) was significantly higher in patients with nonadherent treatments (SEPAR: relative risk [RR], 2.6; 95% confidence interval [CI], 1.1 to 5.6; ATS: RR, 2.5; 95% CI, 1.1 to 5.8). In a multivariate analysis, adherence to ATS guidelines was independently associated with decreased mortality (RR, 0.3; 95% CI, 0.14 to 0.9) after adjusting for the Fine score.


CONCLUSIONS
Adherence was higher to ATS guidelines than to SEPAR guidelines. Severe CAP had a significantly higher mortality when the guidelines (both ATS and SEPAR) were not followed. Length of hospitalization was similar irrespective of adherence to either set of guidelines.
Menéndez
Rosario
R
Pneumology Service, University Hospital La Fe, Valencia, Spain.
Ferrando
David
D
Vallés
José M
JM
Vallterra
Julia
J
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D000900:Anti-Bacterial Agents