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Published ahead of print on June 3, 2005, doi:10.1164/rccm.200411-1444OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 6, September 2005, 757-762

A more recent version of this article appeared on September 15, 2005
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Submitted on November 1, 2004
Accepted on May 31, 2005

Guidelines for the Treatment of Community-Acquired Pneumonia: Predictors of Adherence and Outcome

Rosario Menendez1*, Antoni Torres2, Rafael Zalacain3, Javier Aspa4, Juan J Martin-Villasclaras5, Luis Borderias6, Jose M Benitez-Moya7, Juan Ruiz-Manzano8, Felipe Rodriguez de Castro9, Jose Blanquer10, Diego Perez11, Carmen Puzo12, Fernando Sanchez-Gascon13, Jose Gallardo14, Carlos Alvarez15, and Luis Molinos16

1 Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain, 2 Instituto de Neumologia y Alergia, Hospital Clinic, Barcelona, Spain, 3 Servicio de Neumologia, Hospital de Cruces, Bilbao, Spain, 4 Servicio de Neumologia, Hospital de la Princesa, Madrid, Spain, 5 Servicio de Neumologia, Hospital Carlos Haya, Malaga, Spain, 6 Servicio de Neumologia, Hospital San Jorge, Huesca, Spain, 7 Servicio de Neumologia, Hospital Virgen de la Macarena, Sevilla, Spain, 8 Servicio de Neumologia, Hospital Germans Trias i Pujol, Badalona, Spain, 9 Servicio de Neumologia, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain, 10 Cuidados Intensivos, Hospital Clinico, Valencia, Spain, 11 Servicio de Neumologia, Hospital Clinico, Valencia, Spain, 12 Servicio de Neumologia, Hospital San Pablo, Barcelona, Spain, 13 Servicio de Neumologia, Hospital General Universitario, Murcia, Spain, 14 Servicio de Neumologia, Hospital General, Guadalajara, Spain, 15 Servicio de Neumologia, Hospital 12 de Octubre, Madrid, Spain, 16 Servicio de Neumologia, Hospital Ntra. Sra. de Covadonga, Oviedo, Spain

* To whom correspondence should be addressed. E-mail: rmenend{at}separ.es.

Rationale: Some studies highlight the association of better clinical responses with adherence to guidelines for empirical treatment of community-acquired pneumonia (CAP), but little is known about factors which influence this adherence. Objectives: Our objectives were to identify factors influencing adherence to the guidelines for empirical treatment of CAP, and to evaluate the impact of adherence on outcome. Methods: We studied 1288 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%), non pneumology residents (82%), other specialists (67%). The independent factors related to higher adherence were hospital, physician characteristics and initial high risk class of Fine, while admission to intensive care unit decreased adherence. Seventy-four patients died (6.1%) and treatment failure was found in 175 (14.2%). After adjusting for risk class of Fine, adherence to the guidelines was found protective for mortality (OR 0.55; 95%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. Non-adherence was higher in non-pneumology specialists, and is an independent risk factor for treatment failure and mortality.
Key words: Mortality, antibiotic, compliance, pneumologist, resident




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