title: Impact of antibiotic guideline compliance on duration of mechanical ventilation in critically ill patients with community-acquired pneumonia.
abstract: OBJECTIVE
  Multiple guidelines exist to aid clinicians in choosing antibiotics to treat patients with severe community-acquired pneumonia (SCAP). Our goal was to assess the impact of following these guidelines, such as those from the Infectious Disease Society of America (IDSA), on the duration of mechanical ventilation (MV).
  
  
  METHODS
  Analysis of a prospective registry.
  
  
  METHODS
  Multiple ICUs in Spain.
  
  
  METHODS
  ICU patients with SCAP requiring > or = 24 h of endotracheal intubation and surviving their ICU course.
  
  
  METHODS
  None.
  
  
  RESULTS
  Demographics, comorbid diseases, severity of illness, and process of care variables were recorded. The duration of MV in patients receiving an antibiotic regimen consistent with IDSA guidelines was compared to patients with prescriptions not in accordance with IDSA recommendations. In the cohort (n = 199), Streptococcus pneumoniae was the most frequent pathogen, and unadjusted analysis showed that the duration of MV was longer in persons receiving IDSA-noncompliant regimens (11 days vs 10 days). In a multivariate hazard model, two variables were independently associated with greater durations of MV: development of acute renal failure (hazard ratio, 1.47; 95% confidence interval [CI], 1.02 to 2.12), and prescription of an IDSA-noncompliant regimen (hazard ratio, 1.40; 95% CI, 1.02 to 1.93). Adjusted analysis indicated that patients receiving treatment that was not compliant with IDSA guidelines received MV an added 3 days.
  
  
  CONCLUSIONS
  Failure to follow antibiotic recommendations for the treatment of SCAP may increase the need for continuing MV. Conversely, guideline compliance could represent a surrogate marker that captures other aspects of clinical care, rather than be the direct factor leading to better outcomes. Nonetheless, given the costs associated with MV, enhanced guideline compliance may represent a means for improving outcomes and enhancing resource utilization.
authors.affiliation: Pulmonary and Critical Care Section, Department of Medicine, Room 2A-38D, Washington Hospital Center, Washington, DC 20010, USA. afshorr@dnamail.com
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Maria
authors.initials: M
authors.lastname: Bodi
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Jorge
authors.initials: J
authors.lastname: Sole-Violan
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000145:classification / Q000188:drug therapy; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011014:Pneumonia / Q000145:classification / Q000188:drug therapy*; D012042:Registries; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents