Influence of Deviation From Guidelines on the Outcome of Community-Acquired Pneumonia

Menéndez, Rosário; Ferrando, David Ballester; Valles, José Manuel González y Fernández; Vallterra, J

doi:10.1378/chest.122.2.612

Cited by 97 publications

(69 citation statements)

References 44 publications

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“…Previous studies that analysed the influence of treatment on the duration of hospitalisation obtained discordant results [29,30]. Adherence, or not, to the SEPAR guidelines for the treatment of CAP did not relate significantly with LOS, as has been reported previously by the authors [31] and others [32].…”

Section: Discussionsupporting

confidence: 51%

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Menéndez¹,

Cremades²,

Martínez‐Moragón³

et al. 2003

Eur Respir J

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Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation.Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens.The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals.Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V. Eur Respir J 2003; 22: 643-648. Community-acquired pneumonia (CAP) is the cause of hospitalisation for 3-5 per 1000 adults per year and with a mortality rate of 5-15%. Pneumonia is the infectious disease with the highest health costs [1][2][3][4] and, since approximately one-third of all patients with CAP are treated in hospital, the resulting costs constitute a significant part of the overall direct costs of infectious diseases [5][6][7]. The most important component of these costs is the length of stay (LOS) in hospital and estimates indicate these costs to be higher than those of the diagnostic tests involved and the subsequent antimicrobial treatments administered [6].There is considerable variability in LOS between hospitals. Reported findings are discordant and depend on the types of hospital in which the different studies had been conducted [8][9][10][11]. The differences might reflect variations in clinical practice preferences, hospital characteristics and patient characteristics and attitudes. Over recent years the LOS appears to have decreased from 9 to 6 days [12, 13] as a result of several strategies and practical guidelines that have been proposed in order to safely reduce the number of hospitalisation days [14].The LOS is influenced by several clinical factors, such as the Pneumonia Severity Index (PSI) [15] associated comorbidit...

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Section: Discussionsupporting

confidence: 51%

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Menéndez¹,

Cremades²,

Martínez‐Moragón³

et al. 2003

Eur Respir J

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“…GLEASON et al [27] were unable to show significant differences in medical outcomes in CAP outpatients treated according to, or not according to, the 1993 ATS guidelines. MENENDEZ et al [15] only found significant differences in PSI class V patients, whereas two studies from the University of Texas evaluated a combination of the ATS and IDSA guidelines and found a significant difference in both 30-day mortality and LOS [17,19]. However, these studies were totally retrospective and did not stratify patients according to ATS or IDSA risk group.…”

Section: Discussionmentioning

confidence: 98%

“…MENENDEZ et al [15] validated the 1993 American Thoracic Society (ATS) guidelines and the 1998 joint guidelines from the Spanish Society of Chemotherapy (SEQ) and the Spanish Society of Pulmonology And Thoracic Surgery (SEPAR) for CAP in a prospective study in Spain, finding a higher adherence to ATS guidelines than to SEQ/ SEPAR guidelines, and a higher mortality rate in patients with severe pneumonia in whom one of these guidelines was not followed. HAUCK et al [16] validated a clinical pathway based on the 2000 Infectious Diseases Society of America (IDSA) guidelines [14].…”

mentioning

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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“…Although some earlier studies did not find differences in mortality according to compliance, 21 later reports found a higher mortality, even after adjusting for initial severity, when the treatment used did not comply with the guidelines. [22][23][24][25] However, on multivariate analysis, only initial treatment with quinolones (levofloxacin 89.5%) was independently associated with lower treatment failure, although this effect disappeared when early or late failure was analysed. The newer fluoroquinolones may have contributed to our findings because of their potency, broad spectrum covering S pneumoniae and atypical micro-organisms, and favourable phamacokinetics.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Menéndez

Torres²,

Zalacaín³

et al. 2004

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Influence of Deviation From Guidelines on the Outcome of Community-Acquired Pneumonia

Cited by 97 publications

References 44 publications

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

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

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

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