Background and importance The implementation of community acquired pneumonia (CAP) guidelines has led to shortening the duration of antibiotic treatment, reducing costs and improving pneumonia related morbidity and mortality. Adherence to CAP guidelines is varied in multiple international studies. This study aimed to evaluate the rate of adherence to the 2007 guidelines from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) for the diagnosis and treatment of CAP in hospitalised patients. We also wanted to identify patient related factors that may influence adherence to treatment guidelines at our tertiary care teaching hospital
Aim and objectives The aims of the study were to evaluate adherence to IDSA guidelines for the management of CAP.
Material and methods Patients admitted with CAP had their charts prospectively reviewed from 1 April to 31 July 2018. Patients were eligible to participate in the study if they were >18 years of age and the admitting diagnosis was CAP. Demographic data, comorbid conditions, smoking history, antibiotic culture and sensitivity, duration of antibiotic therapy, relevant laboratory data and diagnostic procedures were retrieved from the medical records. The proportion of patients who were treated according to CAP guidelines were recorded and compared with the most widely referenced guideline, IDSA/ATS for the treatment of CAP.
Results During the study period, 138 eligible patients were identified, 51.4% were women, mean age was 59.1±20 years and 49.3% had diabetes. Only 8% of patients received a single initial empirical antibiotic whereas 92% received combination antibiotics. A total of 122 patients received appropriate initial empirical therapy on the first day of hospitalisation: 9.4% of patients received broad spectrum antibiotics that were not warranted. Eighty-one (58.7%) of the patients had a change in antimicrobial regimen during hospital admission. Overall appropriateness of CAP management based on the composite of initial empirical treatment, duration of treatment and switching antibiotics according to culture and sensitivity during the admission period was 58.0%. Severe respiratory illness was the most significant independent risk factor.
Conclusion and relevance The study showed that adherence to CAP guidelines for an initial empirical therapy on the first day of hospitalisation was optimal whereas overall adherence to CAP management throughout the hospital stay was low.
References and/or acknowledgements No conflict of interest.
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