This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200411-1444OCv1 172/6/757    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Menéndez, R. Search for Related Content PubMed PubMed Citation Articles by Menéndez, R.

Guidelines for the Treatment of Community-acquired Pneumonia

Predictors of Adherence and Outcome

Servicio de Neumología, Hospital Universitario La Fe; Cuidados Intensivos, and Servicio de Neumología, Hospital Clínico, Valencia; Instituto de Neumología y Alergia, Hospital Clinic (Red Gira FIS-ISCIII-03/063); Servicio de Neumología, Hospital San Pablo, Barcelona; Servicio de Neumología, Hospital de Cruces, Bilbao; Servicio de Neumología, Hospital de la Princesa; Servicio de Neumología, Hospital 12 de Octubre, Madrid; Servicio de Neumología, Hospital Carlos Haya, Malaga; Servicio de Neumología, Hospital San Jorge, Huesca; Servicio de Neumología, Hospital Virgen de la Macarena, Sevilla; Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona; Servicio de Neumología, Hospital Dr. Negrín, Las Palmas de Gran Canaria; Servicio de Neumología, Hospital General Universitario, Murcia; Servicio de Neumología, Hospital General, Guadalajara; and Servicio de Neumología, Hospital Ntra. Sra. de Covadonga, Oviedo, Spain

Correspondence and requests for reprints should be addressed to Rosario Menéndez, M.D., Servicio de Neumología, Hospital Universitario La Fe, Avda. de Campanar 21, 46009 Valencia, Spain. E-mail: rmenend{at}separ.es

Rationale: Some studies highlight the association of better clinical responses with adherence to guidelines for empiric treatment of community-acquired pneumonia (CAP), but little is known about factors that influence this adherence. Objectives: Our objectives were to identify factors influencing adherence to the guidelines for empiric treatment of CAP, and to evaluate the impact of adherence on outcome. Methods: We studied 1,288 patients with CAP admitted to 13 Spanish hospitals. Collected variables included the patients' clinical and demographic data, initial severity of the disease, antibiotic treatment, and specialty and training status of the prescribing physician. Measurements and Main Results: Adherence to guidelines was high (79.7%), with significant differences between hospitals (range, 47–97%) and physicians (pneumologists, 81%; pneumology residents, 84%; nonpneumology residents, 82%; other specialists, 67%). The independent factors related to higher adherence were hospital, physician characteristics, and initial high-risk class of Fine, whereas admission to intensive care unit decreased adherence. Seventy-four patients died (6.1%), and treatment failure was found in 175 patients (14.2%). After adjusting for Fine risk class, adherence to the guidelines was found protective for mortality (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.3–0.9) and for treatment failure (OR, 0.65; 95% CI, 0.5–0.9). Treatment prescribed by pneumologists and residents was associated with lower treatment failure (OR, 0.6; 95% CI, 0.4–0.9). Conclusions: Adherence to guidelines mainly depends on the hospital and the specialty and training status of prescribing physicians. Nonadherence was higher in nonpneumology specialists, and is an independent risk factor for treatment failure and mortality.

Key Words: antibiotic • compliance • mortality • pneumologist • resident

This article has been cited by other articles:

				F. W. Arnold, A. S. LaJoie, G. N. Brock, P. Peyrani, J. Rello, R. Menendez, G. Lopardo, A. Torres, P. Rossi, J. A. Ramirez, et al. Improving Outcomes in Elderly Patients With Community-Acquired Pneumonia by Adhering to National Guidelines: Community-Acquired Pneumonia Organization International Cohort Study Results Arch Intern Med, September 14, 2009; 169(16): 1515 - 1524. [Abstract] [Full Text] [PDF]

				P. Schuetz, M. Christ-Crain, R. Thomann, C. Falconnier, M. Wolbers, I. Widmer, S. Neidert, T. Fricker, C. Blum, U. Schild, et al. Effect of Procalcitonin-Based Guidelines vs Standard Guidelines on Antibiotic Use in Lower Respiratory Tract Infections: The ProHOSP Randomized Controlled Trial JAMA, September 9, 2009; 302(10): 1059 - 1066. [Abstract] [Full Text] [PDF]

				T Bewick, V J Cooper, and W S Lim Does early review by a respiratory physician lead to a shorter length of stay for patients with non-severe community-acquired pneumonia? Thorax, August 1, 2009; 64(8): 709 - 712. [Abstract] [Full Text] [PDF]

				A. F. Shorr and R. C. Owens Jr. Guidelines and quality for community-acquired pneumonia: Measures from the Joint Commission and the Centers for Medicare and Medicaid Services Am. J. Health Syst. Pharm., June 15, 2009; 66(12_Supplement_4): S2 - S7. [Abstract] [Full Text] [PDF]

				S. Ewig and T. Welte Evaluation of guidelines for community-acquired pneumonia: a story of confounders, surprises and challenges Eur. Respir. J., October 1, 2008; 32(4): 823 - 825. [Full Text] [PDF]

				F. Blasi, I. Iori, A. Bulfoni, S. Corrao, S. Costantino, and D. Legnani Can CAP guideline adherence improve patient outcome in internal medicine departments? Eur. Respir. J., October 1, 2008; 32(4): 902 - 910. [Abstract] [Full Text] [PDF]

				G. H. Guyatt, P. J. Karanicolas, and R. Kunz Rebuttal From Dr. Guyatt et al Chest, May 1, 2008; 133(5): 1074 - 1075. [Full Text] [PDF]

				G. Barlow, D. Nathwani, E. Myers, F. Sullivan, N. Stevens, R. Duffy, and P. Davey Identifying barriers to the rapid administration of appropriate antibiotics in community-acquired pneumonia J. Antimicrob. Chemother., February 1, 2008; 61(2): 442 - 451. [Abstract] [Full Text] [PDF]

				R. Menendez and A. Torres Treatment Failure in Community-Acquired Pneumonia Chest, October 1, 2007; 132(4): 1348 - 1355. [Abstract] [Full Text] [PDF]

				M. Christ-Crain and B. Muller Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators Eur. Respir. J., September 1, 2007; 30(3): 556 - 573. [Abstract] [Full Text] [PDF]

				S. Fishbane, M. S. Niederman, C. Daly, A. Magin, M. Kawabata, A. de Corla-Souza, I. Choudhery, G. Brody, M. Gaffney, S. Pollack, et al. The Impact of Standardized Order Sets and Intensive Clinical Case Management on Outcomes in Community-Acquired Pneumonia Arch Intern Med, August 13, 2007; 167(15): 1664 - 1669. [Abstract] [Full Text] [PDF]

				F. W. Arnold, J. T. Summersgill, A. S. LaJoie, P. Peyrani, T. J. Marrie, P. Rossi, F. Blasi, P. Fernandez, T. M. File Jr., J. Rello, et al. A Worldwide Perspective of Atypical Pathogens in Community-acquired Pneumonia Am. J. Respir. Crit. Care Med., May 15, 2007; 175(10): 1086 - 1093. [Abstract] [Full Text] [PDF]

				R. Menendez, S. Reyes, R. Martinez, P. de la Cuadra, J. Manuel Valles, and J. Vallterra Economic evaluation of adherence to treatment guidelines in nonintensive care pneumonia Eur. Respir. J., April 1, 2007; 29(4): 751 - 756. [Abstract] [Full Text] [PDF]

				M. S. Niederman Recent Advances in Community-Acquired Pneumonia: Inpatient and Outpatient Chest, April 1, 2007; 131(4): 1205 - 1215. [Abstract] [Full Text] [PDF]

				P. P. Espana, A. Capelastegui, I. Gorordo, C. Esteban, M. Oribe, M. Ortega, A. Bilbao, and J. M. Quintana Development and Validation of a Clinical Prediction Rule for Severe Community-acquired Pneumonia Am. J. Respir. Crit. Care Med., December 1, 2006; 174(11): 1249 - 1256. [Abstract] [Full Text] [PDF]

				J. E. Heffner Update in pulmonary medicine. Ann Intern Med, November 21, 2006; 145(10): 765 - 773. [Full Text] [PDF]

				N. C. Dean, K. A. Bateman, S. M. Donnelly, M. P. Silver, G. L. Snow, and D. Hale Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest, September 1, 2006; 130(3): 794 - 799. [Abstract] [Full Text] [PDF]

				A. Torres and R. Menendez Mortality in COPD patients with community-acquired pneumonia: who is the third partner? Eur. Respir. J., August 1, 2006; 28(2): 262 - 263. [Full Text] [PDF]

				M. Christ-Crain, D. Stolz, R. Bingisser, C. Muller, D. Miedinger, P. R. Huber, W. Zimmerli, S. Harbarth, M. Tamm, and B. Muller Procalcitonin Guidance of Antibiotic Therapy in Community-acquired Pneumonia: A Randomized Trial Am. J. Respir. Crit. Care Med., July 1, 2006; 174(1): 84 - 93. [Abstract] [Full Text] [PDF]

				J. Aspa, O. Rajas, F. Rodriguez de Castro, M. C. Huertas, L. Borderias, F. J. Cabello, J. Tabara, S. Hernandez-Flix, A. Martinez-Sanchis, and A. Torres Impact of initial antibiotic choice on mortality from pneumococcal pneumonia Eur. Respir. J., May 1, 2006; 27(5): 1010 - 1019. [Abstract] [Full Text] [PDF]

				E. B. Milbrandt, A. Ishizaka, and D. C. Angus Update in critical care 2005. Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 833 - 841. [Full Text] [PDF]

				Adherence to CAP Treatment Guidelines Varies by Hospital and Practitioner Journal Watch Infectious Diseases, October 21, 2005; 2005(1021): 7 - 7. [Full Text]

				D. Aujesky and M. J. Fine Does Guideline Adherence for Empiric Antibiotic Therapy Reduce Mortality in Community-acquired Pneumonia? Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 655 - 656. [Full Text] [PDF]