title: Initial management of pneumonia and sepsis: factors associated with improved outcome.
abstract: Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.
authors.affiliation: Servicio de Neumología, Hospital Universitario i Politèctic Butevar sur s/n, 46026 Valencia, Spain. rmenend@separ.es
authors.forename: R
authors.initials: R
authors.lastname: Menéndez
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: S
authors.initials: S
authors.lastname: Reyes
authors.forename: R
authors.initials: R
authors.lastname: Zalacain
authors.forename: A
authors.initials: A
authors.lastname: Capelastegui
authors.forename: J
authors.initials: J
authors.lastname: Aspa
authors.forename: L
authors.initials: L
authors.lastname: Borderías
authors.forename: J J
authors.initials: JJ
authors.lastname: Martín-Villasclaras
authors.forename: S
authors.initials: S
authors.lastname: Bello
authors.forename: I
authors.initials: I
authors.lastname: Alfageme
authors.forename: F R
authors.initials: FR
authors.lastname: de Castro
authors.forename: J
authors.initials: J
authors.lastname: Rello
authors.forename: L
authors.initials: L
authors.lastname: Molinos
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-Manzano
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy*; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000379:methods*; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010100:Oxygen