Empiric management of community-acquired pneumonia in Australian emergency departments.
OBJECTIVE
To describe empiric community-acquired pneumonia (CAP) management in Australian hospital emergency departments (EDs) and evaluate this against national guidelines, including use of the pneumonia severity index and antibiotic selection.


METHODS
A multicentre, cross-sectional, retrospective audit, April 2003 to February 2005.


METHODS
37 Australian hospitals: 22 principal referral hospitals, six large major city hospitals, four large regional hospitals, four medium hospitals and one private hospital.


METHODS
Adult patients with a diagnosis of CAP made in the ED. Data on 20 consecutive CAP ED presentations were collected in participating hospitals.


METHODS
Documented use of the pneumonia severity index, initial antibiotic therapy prescribed in the ED, average length of stay, inpatient mortality, and concordance with national guidelines.


RESULTS
691 CAP presentations were included. Pneumonia severity index use was documented in 5% of cases. Antibiotic therapy covering common bacterial causes of CAP was prescribed in 67% of presentations, although overall concordance with national guidelines was 18%. Antibiotic prescribing was discordant due to inadequate empiric antimicrobial cover, allergy status (including contraindication to penicillin), inappropriate route of administration and/or inappropriate antibiotic choice according to recommendations. There was no significant difference between concordant and discordant antibiotic prescribing episodes in average length of stay (5.0 v 5.7 days; P = 0.22) or inpatient mortality (1.6% v 4.1%; chi2 = 1.82; P = 0.18).


CONCLUSIONS
Antibiotic therapy for CAP prescribed in Australian EDs varied. Concordance with national CAP guidelines was generally low. Targeted interventions are required to improve concordance.
Maxwell
David J
DJ
NSW Therapeutic Advisory Group Inc., PO Box 766, Darlinghurst, NSW 2010, Australia.
McIntosh
Kylie A
KA
Pulver
Lisa K
LK
Easton
Kylie L
KL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D017714:Community-Acquired Infections / Q000145:classification / Q000188:drug therapy*; D000075202:Contraindications; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006767:Hospitals, District; D016304:Hospitals, Private; D006786:Hospitals, Urban; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010406:Penicillins; D011014:Pneumonia / Q000145:classification / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D010406:Penicillins