[Agreement between clinical practice guidelines for management of community-acquired pneumonia. A retrospective study of 101 hospitalized patients].
BACKGROUND
Management guidelines for acute community acquired pneumonia vary considerably. The objective is to estimate by a retrospective study the uniformity of the recommendations for the management of patients and the choice of initial empirical antibiotic therapy.


METHODS
Eight English and French language guidelines published between 1998 and 2001 were identified by a search of the literature. They were applied retrospectively to a sample of 101 patients admitted to a university hospital in 2000 with a diagnosis of pneumonia.


RESULTS
Hospital admission was advocated for between 61% and 95% and admission to intensive care for between 8% and 35% of the patients, depending on the guidelines under consideration. The actual management conformed to that advocated for between 34% and 94% of the patients (kappa=0.27 [0,19; 0,34]). Compliance of the empirical antibiotic therapy (drug, dose, mode of administration) with the recommendations varied from 0% to 68% of the patients depending on the guidelines considered (kappa=0.01 [-0,10; 0,12]).


CONCLUSIONS
The heterogeneity of the guidelines is manifest by important variations in the recommendations for management and initial empirical therapy. These differences are due, in part, to a paucity of evidence based data upon which to base the guidelines. It would appear essential to harmonise the guidelines in a way that is appropriate for the country of their intended use.
Labarère
J
J
Unité d'Evaluation Médicale, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. jlabarere@chu-grenoble.fr
Fourny
M
M
Pavese
P
P
Bedouch
P
P
Brambilla
C
C
François
P
P
D000208:Acute Disease; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002170:Canada; D017714:Community-Acquired Infections / Q000188:drug therapy; D032921:Consensus; D005060:Europe; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States
D000900:Anti-Bacterial Agents