title: Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia.
abstract: BACKGROUND
  Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older).
  
  
  METHODS
  Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models.
  
  
  RESULTS
  A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality.
  
  
  CONCLUSIONS
  The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.
authors.affiliation: Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rossio
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: carlotta.franchi@marionegri.it.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ardoino
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Codjo D
authors.initials: CD
authors.lastname: Djade
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.affiliation: Department of Medical and Surgery Sciences, IRCCS Policlinico San Donato, University of Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.affiliation: Department of Clinical and Experimental Science, University of Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.affiliation: Geriatrics Unit, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.affiliation: Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
authors.forename: Flora
authors.initials: F
authors.lastname: Peyvandi
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy.
authors.forename: Elia M
authors.initials: EM
authors.lastname: Biganzoli
authors.affiliation: Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.affiliation: Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Policlinico Foundation, Milan, Italy.
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Elderly; Guidelines adherence; Mortality; Pneumonia; Re-hospitalization