Adherence to guideline's empiric antibiotic recommendations and CAP outcome

¹ Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tòrax (ICT), Hospital Clínic, Ciber Enfermedades Respiratorias, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
² Servei de Malalties Infeccioses, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
³ Servei de Microbiologia, Institut Clínic de Diagnòstic Biomèdic (CDB), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
⁴ Servei de Medicina Interna, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
⁵ Àrea d'Urgències, Direcció mèdica, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Villarroel 170, 08036, Barcelona, Spain
⁶ Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
⁷ Dept of Medicine, Winthrop-University Hospital, Minneola, NY 11501, USA

^* To whom correspondence should be addressed. E-mail: atorres{at}ub.edu.

	Abstract

The ATS published guidelines for the treatment and management of CAP (2001), but the impact of adherence on outcomes such as mortality and length of stay is not well defined.

We carried out a study of 780 patients with CAP consecutively admitted to the hospital in one year. Nursing home (NH) patients were excluded.

Overall adherence to antibiotics recommended in the ATS guidelines was 84%. The lowest adherence was found in patients admitted to an ICU (52%), especially those at risk for infection with Pseudomonas aeruginosa (ATS group IVb). However, very few patients from this group actually were infected with Pseudomonas aeruginosa. This could be explained by the exclusion of the NH patients.

There was a difference in mortality between patients that received adherent and non-adherent regimens (3% vs. 10.6%, p < 0.001). There was a difference in length of stay (7.6 vs.10.4 days respectively, p = 0.004) between patients receiving adherent and non-adherent regimens. This result was confirmed in a multivariate analysis (OR: 0.60; p=0.049).

Adherence to the 2001 ATS guidelines was high except in CAP patients admitted to an intensive care unit. Length of stay was lower in patients who received adherent than those receiving non-adherent antibiotic regimens.

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