title: Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital: A Retrospective Review.
abstract: OBJECTIVE
  The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen.
  
  
  METHODS
  A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision (ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy.
  
  
  RESULTS
  Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55.
  
  
  CONCLUSIONS
  Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP.
authors.affiliation: Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, AL, USA.
authors.forename: Beth L
authors.initials: BL
authors.lastname: Erwin
authors.affiliation: Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA jakyle@samford.edu.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kyle
authors.affiliation: Southeastern Infectious Diseases, Alabaster, AL, USA.
authors.forename: Leland N
authors.initials: LN
authors.lastname: Allen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D057286:Electronic Health Records / Q000592:standards / Q000639:trends; D036262:Empirical Research; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000639:trends; D006764:Hospitals, Community / Q000379:methods / Q000592:standards* / Q000639:trends; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: empiric antibiotic therapy; health care-associated pneumonia; hospital-acquired pneumonia; lower respiratory tract infection; ventilator-associated pneumonia