The implementation of IDSA/ATS and the Greek national guidelines for CAP by chest physicians in Greece

Abstract

BACKGROUND: There is not enough evidence concerning the implementation of practice guidelines for CAP and its impact on cost and patients' outcome.

MATERIAL & METHOD: A prospective observational study incorporating 300 immunocompetent hospitalised pts with CAP. The aim was to determine whether the 2007 IDSA/ATS and the Greek National Guidelines for CAP are implemented by Chest Physicians in “Sotiria” General Hospital. We assessed whether: a)hospital admission was correct or not, b)the administered initial antimicrobial chemotherapeutic regimen was in accordance to guidelines or not. We applied Fine Score (PSI) to determine the severity of CAP. 193 pts were male, 107 female. Comorbidities emerged in 208 pts.

RESULTS: The mortality rate was 12.67%. COPD pts performed a statistically significant higher mortality rate compared to non COPD pts (23.08% vs 10.48% respectively, p=0.024). A microbial pathogen was identified in 66 (22%) cases and Streptococcus Pn. was the predominant pathogen isolated (30.3%). The implementation of CAP guidelines concerning the initial antimicrobial regimen was poor (179 pts, 59.7%). Urine Antigens and Blood Cultures performed the highest yield among all other diagnostic techniques (16.2% & 16% respectively). Pts treated with an initial antimicrobial in accordance to guidelines performed a trend towards lower mortality and shorter LOS compared to those in discordance (p=0.067 and p=0.056). 144 (48%) pts were classified as Risk Class I or II and therefore could be treated as outpatients.

CONCLUSION: The implementation of CAP guidelines by Greek Chest Physicians is poor incurring a negative impact on patients' outcome, on LOS and the financial burden of Greek NHS.