help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
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
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200411-1444OCv1
172/6/757    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Menendez, R.
Right arrow Articles by Molinos, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Menendez, R.
Right arrow Articles by Molinos, L.

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




This article has been cited by other articles:


Home page
 Arch Intern MedHome page
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]

Home page
 JAMAHome page
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]

Home page
 ThoraxHome page
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]

Home page
 Am J Health Syst PharmHome page
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]

Home page
 Eur Respir JHome page
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]

Home page
 Eur Respir JHome page
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]

Home page
 ChestHome page
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]

Home page
 J Antimicrob ChemotherHome page
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]

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

Home page
 Eur Respir JHome page
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]

Home page
 Arch Intern MedHome page
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]

Home page
 Am. J. Respir. Crit. Care Med.Home page
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]

Home page
 Eur Respir JHome page
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]

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

Home page
 Am. J. Respir. Crit. Care Med.Home page
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]

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

Home page
 ChestHome page
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]

Home page
 Eur Respir JHome page
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]

Home page
 Am. J. Respir. Crit. Care Med.Home page
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]

Home page
 Eur Respir JHome page
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]

Home page
 Am. J. Respir. Crit. Care Med.Home page
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]

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

Home page
 Am. J. Respir. Crit. Care Med.Home page
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]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2005 American Thoracic Society 		  CCM abstracts