Improved Clinical Outcomes With Utilization of a Community-Acquired Pneumonia Guideline

Dean, Nathan C.; Bateman, Kim; Donnelly, Steven M.; Silver, Michael; Snow, Greg; Hale, David E

doi:10.1378/chest.130.3.794

Cited by 130 publications

(82 citation statements)

References 34 publications

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“…Of those 13 patients, 4 were admitted to the ICU. Other authors (7,16) have reported 30-day mortality rates of 11.7% and 13.4%, which are similar to those found in the present study. There were no differences between the 30-day mortality rates predicted by the CURB-65 and CRB-65 scores (0-1, 2, and 3-5; and 0, 1-2, and 3-4, respectively) in the present study and those found by Lim et al in the study validating those scores.…”

Section: Discussionsupporting

confidence: 92%

“…(6,17) Previous studies have reported that guideline-concordant antibiotic therapy is associated with lower short-term mortality rates. (7,16,17) A study conducted in Brazil showed a trend toward a reduction in the overall mortality rate after the implementation of CAP guidelines. (18) In the present study, that was true only for the patients with a CRB-65 score of 1-2.…”

Section: Discussionmentioning

confidence: 99%

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Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

2012

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Objective: To evaluate the agreement between the criteria used for hospitalization of patients with communityacquired pneumonia (CAP) and those of the Brazilian Thoracic Association guidelines, and to evaluate the association of that agreement with 30-day mortality. Secondarily, to evaluate the agreement between the treatment given and that recommended in the guidelines with length of hospital stay, microbiological profile, 12-month mortality, complications, ICU admission, mechanical ventilation, and 30-day mortality. Methods: This was a retrospective study involving adult patients hospitalized between 2005 and 2007 at the Federal University of Minas Gerais Hospital das Clínicas, located in Belo Horizonte, Brazil. Medical charts and chest X-rays were reviewed. Results:Among the 112 patients included in the study, admission and treatment criteria were in accordance with the guidelines in 82 (73.2%) and 66 (58.9%), respectively. The 30-day and 12-month mortality rates were 12.3% and 19.4%, respectively. The 30-day mortality rate was lower for patients in whom the CRB-65 (mental Confusion, Respiratory rate, Blood pressure, and age ≥ 65 years) score was 1-2 and the antibiotic therapy was in accordance with the guidelines (p = 0.01). Cerebrovascular disease and appropriate antibiotic therapy showed independent associations with 30-day mortality. There was a trend toward an association between guidelineconcordant antibiotic therapy and shorter hospital stay. Conclusions: In the population studied, admission and treatment criteria that were in accordance with the guidelines were associated with favorable outcomes in hospitalized patients with CAP. Cerebrovascular disease, as a risk factor, and guideline-concordant antibiotic therapy, as a protective factor, were associated with 30-day mortality.Keywords: Pneumonia/therapy; Pneumonia/mortality; Hospitalization; Guideline adherence. ResumoObjetivo: Avaliar a concordância entre os critérios de hospitalização utilizados para a admissão de pacientes com pneumonia adquirida na comunidade (PAC) e aqueles da Sociedade Brasileira de Pneumologia e Tisiologia e avaliar a associação dessa concordância com a taxa de mortalidade em 30 dias. Secundariamente, avaliar a associação da concordância entre o tratamento instituído e as recomendações dessas diretrizes com duração da internação hospitalar, investigação microbiológica, mortalidade em 12 meses, complicações, internação em UTI, ventilação mecânica e mortalidade em 30 dias. Métodos: Estudo retrospectivo que incluiu pacientes adultos internados entre 2005 e 2007 no Hospital das Clínicas da Universidade Federal de Minas Gerais, na cidade de Belo Horizonte (MG). Foram revisados prontuários e radiografias de tórax. Resultados: Dentre os 112 pacientes incluídos, os critérios de internação e de tratamento foram concordantes com as diretrizes em 82 (73,2%) e 66 (58,9%), respectivamente. A taxa de mortalidade em 30 dias e em 12 meses foi de 12,3% e 19,4%, respectivamente. Pacientes com escore de CRP-65 (Confusão mental, frequênci...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

2012

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“…However, these studies were totally retrospective and did not stratify patients according to ATS or IDSA risk group. DEAN et al [28] found decreased mortality and LOS after the implementation of local guidelines based on a combination of local practices and IDSA and ATS guidelines. In the present study, the relationship between antibiotic adherence to the 2001 ATS guidelines for CAP and two important outcomes, mortality and LOS, was examined.…”

Section: Discussionmentioning

confidence: 99%

Adherence to guidelines’ empirical antibiotic recommendations and community-acquired pneumonia outcome

Dambrava

Torres²,

Vallès³

et al. 2008

Eur Respir J

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The American Thoracic Society (ATS) published guidelines for the treatment and management of community-acquired pneumonia in 2001, but the impact of adherence on outcomes such as mortality and length of stay is not well defined.A study of 780 patients with community-acquired pneumonia consecutively admitted to hospital over 1 yr was carried out. Nursing home patients were excluded.Overall adherence to antibiotics recommended in the ATS guidelines was 84%. The lowest adherence was found in patients admitted to an intensive care unit (52%), especially those at risk of infection withPseudomonas aeruginosa(ATS group IVb). However, very few patients from this group were indeed infected withP. aeruginosa. This could be explained by the exclusion of the nursing home patients. There was a difference in mortality between patients that received adherent and nonadherent regimens (3versus10.6%). There was a difference in length of stay between patients receiving adherent and nonadherent regimens (7.6versus10.4 days). This result was confirmed on multivariate analysis.Adherence to the 2001 American Thoracic Society guidelines was high except in community-acquired pneumonia patients admitted to an intensive care unit. Length of stay was shorter in patients who received adherent rather than nonadherent antibiotic regimens.

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“…computerisation of records, decision support system) [5]. Numerous studies [6][7][8] have shown the effectiveness of ASP and its interventions; and recently, there is an _________________________________________ increasing emphasis in evaluating cost-effectiveness upon implementation of these interventions. The recent reviews involved a large variation in the method and depth of ASP being economically evaluated (i.e.…”

Section: Introductionmentioning

confidence: 99%

Economic Evaluations on Antimicrobial Stewardship Programme: A Systematic Review

Ibrahim¹,

Maruan²,

Khairy³

et al. 2017

J Pharm Pharm Sci

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-Purpose:To systematically review studies on cost-effectiveness of implementing Antimicrobial stewardship programmes (ASP) in the hospital setting. Methods: A systematic literature search was performed using electronic databases, such as EMBASE, PubMed/Medline, CINAHL, NHS and CEA Registry from 2000 until 2017. The quality of each included study was assessed using Joanna Briggs Institute Critical Appraisal Checklist for Economic Evaluations and Consolidated Health Economic Evaluation Reporting Standards Statement checklist. Results: Of the 313 papers retrieved, five papers were included in this review after assessment for eligibility. The majority of the studies were cost-effectiveness studies, comparing ASP to standard care. Four included economic studies were conducted from the provider (hospital) perspective while the other study was from payer (National Health System) perspective. The cost included for economic analysis were as following: personnel costs, warded cost, medical costs, procedure costs and other costs. Conclusions: All studies were generally well-conducted with relatively good quality of reporting. Implementing ASP in the hospital setting may be cost-effective. However, comprehensive cost-effectiveness data for ASP remain relatively scant, underlining the need for more prospective clinical and epidemiological studies to incorporate robust economic analyses into clinical decisions.

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Improved Clinical Outcomes With Utilization of a Community-Acquired Pneumonia Guideline

Cited by 130 publications

References 34 publications

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

Adesão a diretrizes e impacto nos desfechos em pacientes hospitalizados por pneumonia adquirida na comunidade em um hospital universitário

Adherence to guidelines’ empirical antibiotic recommendations and community-acquired pneumonia outcome

Economic Evaluations on Antimicrobial Stewardship Programme: A Systematic Review

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