title: Causes of non-adherence to therapeutic guidelines in severe community-acquired pneumonia.
abstract: OBJECTIVE
  To assess the adherence to Infectious Disease Society of America/American Thoracic Society guidelines and the causes of lack of adherence during empirical antibiotic prescription in severe pneumonia in Latin America.
  
  
  METHODS
  A clinical questionnaire was submitted to 36 physicians from Latin America; they were asked to indicate the empirical treatment in two fictitious cases of severe respiratory infection: community-acquired pneumonia and nosocomial pneumonia.
  
  
  RESULTS
  In the case of community acquired pneumonia, 11 prescriptions of 36 (30.6%) were compliant with international guidelines. The causes for non-compliant treatment were monotherapy (16.0%), the unnecessary prescription of broad-spectrum antibiotics (40.0%) and the use of non-recommended antibiotics (44.0%). In the case of nosocomial pneumonia, the rate of adherence to the Infectious Disease Society of America/American Thoracic Society guidelines was 2.8% (1 patient of 36). The reasons for lack of compliance were monotherapy (14.3%) and a lack of dual antibiotic coverage against Pseudomonas aeruginosa (85.7%). If monotherapy with an antipseudomonal antibiotic was considered adequate, the antibiotic treatment would be adequate in 100% of the total prescriptions.
  
  
  CONCLUSIONS
  The compliance rate with the Infectious Disease Society of America/American Thoracic Society guidelines in the community-acquired pneumonia scenario was 30.6%; the most frequent cause of lack of compliance was the indication of monotherapy. In the case of nosocomial pneumonia, the compliance rate with the guidelines was 2.8%, and the most important cause of non-adherence was lack of combined antipseudomonal therapy. If the use of monotherapy with an antipseudomonal antibiotic was considered the correct option, the treatment would be adequate in 100% of the prescriptions.
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Simone
authors.initials: S
authors.lastname: Gattarello
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Sergio
authors.initials: S
authors.lastname: Ramírez
authors.affiliation: Servicio de Medicina Intensiva, Clínica Comfamiliar, Universidad Tecnológica de Pereira, Risaralda, Colombia.
authors.forename: José Rafael
authors.initials: JR
authors.lastname: Almarales
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Borgatta
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Leonel
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Belén
authors.initials: B
authors.lastname: Encina
authors.affiliation: Servicio de Medicina Intensiva, Institut de Recerca Vall d'Hebron (VHIR); Hospital Universitario Vall d'Hebron, Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D007843:Latin America; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents