[Management of acute community-acquired pneumonia in a health centre. Assessment of 101 cases using the retrospective clinical audit method].
OBJECTIVE
To assess the conformity of practitioners' practices in the management of community acquired pneumonia with the French Agence Nationale d'Accréditation et d'Evaluation en Santé (Anaes) guidelines.


METHODS
We retrospectively reviewed a random sample of 210 medical records which included a principal or associated diagnosis of pneumonia in a French university hospital.


RESULTS
A hundred and one medical records were assessable. Sixty-two patients were high risk (Pneumonia Severity Index class IV or V of the prediction rule of Fine et al.), and 10 patients were admitted into an intensive care unit. The overall in-hospital mortality was 14 patients [8-22]. The level of care was appropriate according to the guidelines in 40 cases ([30-50)]. Seven patients did not require hospitalisation, 31 patients required admission into a medical department, 56 patients into an intensive care unit and 7 patients were managed in non specified conditions. Eighteen patients ([11-27]) had appropriate microbiologic investigations. Forty-three patients (([33-53]) received antibiotics within 8 hours of arrival. Empirical antibiotic treatment (dosage and molecule) was appropriate in 38 patients ([28-48]). There was no significant relationship between compliance with the guidelines and in-hospital mortality.


CONCLUSIONS
The rate of conformity of practitioners' practices with the Anaes guidelines for management of community-acquired pneumonia is low in our hospital. It could be improved by active implementation of these guidelines.
Labarère
José
J
Unité d'évaluation médicale, CHU de Grenoble. JLabarere@chu-grenoble.fr
Fourny
Magali
M
Arnould
Julie
J
Bedouch
Pierrick
P
Olive
Frédéric
F
Pavese
Patricia
P
Brambilla
Christian
C
François
Patrice
P
D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy; D003625:Data Collection; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006268:Health Facilities; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies