Abstract
Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia. In sepsis, bundles of processes of care have also increased survival. We aimed to audit in hospitalised CAP with sepsis, compliance with guideline-recommended processes of care and its impact on outcome.
We prospectively studied 4137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were antibiotic adherence to guidelines, first dose within 6 hours and oxygen assessment. Outcome measures were mortality and length of stay.
Oxygen assessment was measured in 3745 patients (90.5%), 3024 patients (73.1%) received antibiotics according to guidelines and 3053 (73.8%) received antibiotics within 6 hours. In CAP with sepsis, the strongest independent factor for survival was antibiotic adherence (odds ratio OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for Fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay.
In sepsis, antibiotic adherence is the strongest protective factor care associated with survival and length of stay. In severe sepsis, combined antibiotic adherence and first dose within 6 hours may reduce mortality.
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