Poor adherence to South African guidelines for the management of community-acquired pneumonia.
OBJECTIVE
To evaluate adherence to the South African guidelines for the management of community-acquired pneumonia (CAP) and to determine whether adherence reduced length of hospital stay and mortality in patients with severe CAP.


METHODS
King Edward VIII Hospital, Durban.


METHODS
Four hundred and thirty patients with CAP were recruited between June 2000 and October 2001. Severity assessment data were collected. Severe CAP was defined by the presence of two or more markers. Without influence from the investigators, the admitting team chose the empirical antibiotic regimen. Antibiotics administered, outcome and length of stay were analysed.


RESULTS
Two hundred and eighty-seven of 430 patients were eligible for analysis. One hundred and eighty-two patients had two or more markers of severe CAP. Fourteen of the 182 patients (8%) had initial antibiotic therapy administered according to South African guidelines and 168 (92%) did not. The mortality rate was 20% (36 patients). Accounting for sample size there was no statistically significant difference in length of stay between the two groups (14 v. 12 days, p = 1.0000, odds ratio (OR) 1.167, 95% confidence interval (CI): 0.3926 - 3.467) or in mortality rate (28.5% v. 19%, p = 0.3549, OR 1.667, 95% CI: 0.667 - 4.161).


CONCLUSIONS
There was very poor adherence with South African CAP antibiotic guidelines. The sample size of patients receiving treatment according to the South African Thoracic Society (SATS) guidelines was too low to confirm confidently that adherence may have resulted in a clinical benefit.
Nyamande
K
K
Department of Pulmonology, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Durban.
Lalloo
U G
UG
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology; D019983:Guideline Adherence / Q000639:trends*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents