[Medical outcomes and antimicrobial compliance according to the Chilean Society of Respiratory Diseases guidelines for hospitalized patients with community acquired pneumonia].
BACKGROUND
The Chilean Society of Respiratory Diseases (SER) developed guidelines for the empirical treatment of community acquired pneumonia (CAP).


OBJECTIVE
To evaluate the degree of adherence to antibiotic treatment recommended by SER guidelines and its influence on medical outcomes.


METHODS
We prospectively evaluated 453 consecutive immunocompetent adults (mean age +/- SD: 69 +/- 19 years) hospitalized for CAP. Patients were stratified according to the Pneumonia Severity Index (PSI), and initial antibiotic regimen was classified as being consistent or inconsistent with the SER guidelines. Rate of medical complications, switch therapy rate, length of stay (LOS), and 30 days mortality were compared between those treated consistently or inconsistently with the SER guidelines.


RESULTS
Adherence to SER guidelines was 46%. Patients treated consistently with the SER guidelines were older (mean age +/- SD: 72 +/- 16 v/s 65 +/- 20 years), had more comorbidities (84 v/s 69%) and a higher proportion belonged to the high-risk PSI categories (69 v/s 49%). There were no significant differences in medical complication rate, switch therapy rate or LOS between both groups. Adherence to SER guidelines did not affect mortality after adjusting for PSI and for prognostic factors associated with 30 days mortality by multivariate analysis.


CONCLUSIONS
The degree of adherence to antibiotic treatment recommended by SER guidelines was moderate and they were applied mainly in patients with high risk CAP. This fact can explain the lack of evidence of improved medical outcome in patients treated according to SER guidelines.
Díaz
Alejandro
A
Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 345, 4o Piso, Santiago, Chile. alediazf@hotmail.com
Kuzmanic
Gabriela
G
Platzer
Liesbeth
L
Sanfuentes
Francisca
F
Espinoza
Manuel A
MA
Saldías
Fernando
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002677:Chile / Q000453:epidemiology; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies
D000900:Anti-Bacterial Agents