Improving Outcomes in Elderly Patients With Community-Acquired Pneumonia by Adhering to National Guidelines

Arnold, Forest W.

doi:10.1001/archinternmed.2009.265

Cited by 109 publications

(68 citation statements)

References 44 publications

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“…In this study carried out in the elderly overall adherence to clinical guidelines was poor, because also for CAP it was less than 50%, slightly lower than in other studies [7,8,14], but it was even lower for HAP (29%) and HCAP (25%). The lack of specific microbiological test could, at least, explain the poor adherence among CAP.…”

Section: Discussioncontrasting

confidence: 70%

“…Furthermore, a paucity of studies has specifically considered the hospitalized elderly population [8]. With this background, the aims of this study were to evaluate adherence to IDSA/ATS guidelines and its relationship with the main clinical outcomes (length of hospital stay, re-hospitalization rate, in-hospital and 3-month mortality) in elderly people consecutively admitted to Italian internal medicine and geriatric wards participating in the prospective REPOSI registry.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Rossio¹,

Franchi²,

Ardoino³

et al. 2015

European Journal of Internal Medicine

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Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

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Section: Discussioncontrasting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Rossio¹,

Franchi²,

Ardoino³

et al. 2015

European Journal of Internal Medicine

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“…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: 79%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

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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.

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“…Even in severe forms of CAP, an early-switch strategy is usually possible on day 3 of admission [3]. Large-scale implementation of early-switch strategies would lead to a substantial reduction in healthcare costs [3,4]. Therefore, (inter-)national guidelines advocate an early switch to oral treatment for hospitalised CAP patients [1,5,6].…”

mentioning

confidence: 99%

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

Engel

Postma

Hulscher³

et al. 2012

European Respiratory Journal

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Do physicians apply an early-switch strategy (from intravenous to oral antibiotics) in clinically stable patients hospitalised with community-acquired pneumonia (CAP)? If not, why not?In a multicentre prospective cohort study, adult patients admitted for i.v. CAP treatment were included. On day 3 of antibiotic treatment, clinical stability was assessed and treating resident physicians were interviewed on their switch strategies. Additionally, treating physicians were interviewed to evaluate their knowledge of and adherence to guideline advice.149 (92%) out of 162 patients were included and 97 (91%) out of 107 physicians were interviewed. A switch to oral antibiotics was possible in 68 (46%) out of 149 patients on day 3 of treatment but not performed in 27 (40%) out of 68. Patient factors delaying the switch were high CURB-65 (confusion of new onset, urea .7 mmol?L -1 , respiratory rate of o30 breaths?min -1 , blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs) score (on admission) (p50.04) and oxygen treatment (p50.04), high temperature (p50.00) and high respiration rate (p50.04) (day 3). Physicians' barriers to an early switch in clinically stable patients included misconceptions (26 (55%) out of 47), practical considerations (13 (28%) out of 47) and organisational factors (eight (17%) out of 47). Strikingly, 91 (94%) out of 97 interviewed physicians were not aware of guideline advice. The switch from i.v. to oral antibiotics is often unnecessarily delayed in patients hospitalised with CAP due to different types of barriers.

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Improving Outcomes in Elderly Patients With Community-Acquired Pneumonia by Adhering to National Guidelines

Abstract: Implementation of national guidelines at the local hospital level will improve not only mortality and LOS of elderly patients hospitalized with CAP but also time to clinical stability.

Cited by 109 publications

References 44 publications

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Management of community-acquired pneumonia

Barriers to an early switch from intravenous to oral antibiotic therapy in hospitalised patients with CAP

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