[Questionnaire survey of guideline implementation for community acquired pneumonia with retrospective analysis of the empiric treatment in 490 patients].
OBJECTIVE
To assess physicians' awareness and use of guidelines for community-acquired pneumonia (CAP) published by Chinese Society of Respiratory Diseases (CSRD) and American Thoracic Society (ATS), and to investigate influences of the guidelines on the prognosis of patients with CAP.


METHODS
A total of 210 self-completion questionnaires about CAP guidelines were received from doctors of six hospitals in Beijing. In addition, 490 serial cases of CAP collected from these hospitals admitted from January 2002 to December 2003 were retrospectively analyzed.


RESULTS
Most doctors had limited knowledge about atypical pathogens. For pulmonary physicians, only 46% (97/210) reported using the CSRD guideline. 82.4% of the doctors preferred to give initial empiric antibiotic therapy according to the patients' conditions. 79.5% (167/210) of the doctors ordered examination of the pathogens routinely and 84.3% (177/210) of them admitted its usefulness for choosing antibiotics. 84.5% (414/490) of the patients responded well to the initial empiric treatment. Patients who were treated according to the guidelines of CSRD and ATS were 229 cases and 131 cases respectively. There was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not. There was no significant difference in the prognosis between cases with definite pathogens and cases without.


CONCLUSIONS
The results indicate low levels of awareness and use of guidelines for the management of CAP. Fewer than half of the patients were treated according to the guidelines. However, the treatments were effective in most of the patients, and there was no significant difference in the prognosis between patients who were treated according to the guideline and those who were not, because broad-spectrum antibiotics were overused. More effective guideline implementation strategies are needed to encourage compliance with practice guidelines for the management of CAP.
Department of Respiratory Medicine, Peking Union Medical College, Peking Union Medical Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zuo-jun
ZJ
Xu
Ke
K
Ding
Hui
H
Huang
Tie-ying
TY
Sun
Hui-xing
HX
Ke
Zhao-hui
ZH
Tong
Tian-ni
TN
Wei
Kun
K
Peng
Bin
B
Yao
Feng-xian
FX
Li
Jian-hua
JH
Liu
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000628:therapy*; D003625:Data Collection / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents