Guidelines for the treatment of community-acquired pneumonia: predictors of adherence and outcome.
BACKGROUND
Some studies highlight the association of better clinical responses with adherence to guidelines for empiric treatment of community-acquired pneumonia (CAP), but little is known about factors that influence this adherence.


OBJECTIVE
Our objectives were to identify factors influencing adherence to the guidelines for empiric treatment of CAP, and to evaluate the impact of adherence on outcome.


METHODS
We studied 1,288 patients with CAP admitted to 13 Spanish hospitals. Collected variables included the patients' clinical and demographic data, initial severity of the disease, antibiotic treatment, and specialty and training status of the prescribing physician.


RESULTS
Adherence to guidelines was high (79.7%), with significant differences between hospitals (range, 47-97%) and physicians (pneumologists, 81%; pneumology residents, 84%; nonpneumology residents, 82%; other specialists, 67%). The independent factors related to higher adherence were hospital, physician characteristics, and initial high-risk class of Fine, whereas admission to intensive care unit decreased adherence. Seventy-four patients died (6.1%), and treatment failure was found in 175 patients (14.2%). After adjusting for Fine risk class, adherence to the guidelines was found protective for mortality (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.3-0.9) and for treatment failure (OR, 0.65; 95% CI, 0.5-0.9). Treatment prescribed by pneumologists and residents was associated with lower treatment failure (OR, 0.6; 95% CI, 0.4-0.9).


CONCLUSIONS
Adherence to guidelines mainly depends on the hospital and the specialty and training status of prescribing physicians. Nonadherence was higher in nonpneumology specialists, and is an independent risk factor for treatment failure and mortality.
Menéndez
Rosario
R
Servicio de Neumología, Hospital Universitario La Fe, Avda. de Campanar 21, 46009 Valencia, Spain. rmenend@separ.es
Torres
Antoni
A
Zalacaín
Rafael
R
Aspa
Javier
J
Martín-Villasclaras
Juan J
JJ
Borderías
Luis
L
Benítez-Moya
José M
JM
Ruiz-Manzano
Juan
J
de Castro
Felipe Rodríguez
FR
Blanquer
José
J
Pérez
Diego
D
Puzo
Carmen
C
Sánchez-Gascón
Fernando
F
Gallardo
José
J
Alvarez
Carlos
C
Molinos
Luis
L
D017714:Community-Acquired Infections / Q000628:therapy*; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D016015:Logistic Models; D010820:Physicians; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D015272:Pulmonary Medicine; D017211:Treatment Failure; D016896:Treatment Outcome