Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia

McCabe, Caitlin; Kirchner, Cheryl; Zhang, Huiling; Daley, Jennifer; Fisman, David N.

doi:10.1001/archinternmed.2009.259

Cited by 185 publications

(124 citation statements)

References 41 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…This reduction in mortality with macrolides is possibly attributable to their immunomodulatory and antiinflammatory effect. Similar outcomes have been reported in other studies measuring the effect of guideline-compliant antibiotic treatment and outcomes [37,38]. This beneficial effect of macrolides on mortality was not seen in a recent systematic review, which could have been the result of small numbers and relatively less severe CAP in the trials included, resulting in the lack of appreciable mortality benefit [39].…”

Section: Treatmentsupporting

confidence: 80%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

View full text Add to dashboard Cite

This article summarizes recent literature related to community-acquired pneumonia (CAP), which continues to represent one of the most common causes of morbidity and mortality throughout the world, especially in the elderly. The impact is even more striking if we take healthcare costs into account. Patients with CAP usually have other comorbidities which not only increase mortality in this group but also add further to its economic burden. Patients with COPD, preexisting cardiac disease, and diabetes are particularly at higher risk for developing more severe pneumonia. New diagnostic modalities, including ultrasonography, are being used more commonly in clinical practice. Procalcitonin levels can be used to identify bacterial pneumonia and to de-escalate antibiotic therapy, resulting in fewer days on antibiotics. Other biomarkers have been used in studies to stratify patients by risk. Guideline-concordant regimens including atypical coverage, and macrolides in particular, appear to provide benefit. More recent data suggest the need for careful screening of patients for cardiovascular risk factors prior to initiating macrolides and fluoroquinolones.

show abstract

Section: Treatmentsupporting

confidence: 80%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

View full text Add to dashboard Cite

show abstract

“…Two studies evaluating ward patients exclusively found guideline-concordant antibiotic therapy in 57% and 65% of the cases. (21,22) In those studies, guideline-concordant antibiotic therapy was found to be associated with shorter hospital stays and reduced complications. Likewise, we found a four-day reduction in the length of hospital stay among the patients who received treatment that was in accordance with the recommendations, a trend toward significance having been observed (p = 0.066).…”

Section: Discussionmentioning

confidence: 99%

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

2012

View full text Add to dashboard Cite

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...

show abstract

“…The application of such guidelines has been correlated with improved outcomes 4 , but also with an increase in the use of, and subsequent resistance to macrolide and fluoroquinolone antibiotics 5,6 . patients admitted to general medical services.…”

Section: Literature Reviewmentioning

confidence: 99%

New evidence prompts rethinking the clinical management of community acquired pneumonia in patients admitted to general medical services

Caldwell

2015

Clin. Res. Pract.

View full text Add to dashboard Cite

Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia

Cited by 185 publications

References 41 publications

Management of community-acquired pneumonia

Management of community-acquired pneumonia

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

New evidence prompts rethinking the clinical management of community acquired pneumonia in patients admitted to general medical services

Contact Info

Product

Resources

About