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. 2015 Jan-Mar;27(1):44-50.
doi: 10.5935/0103-507X.20150008. Epub 2015 Mar 1.

Causes of non-adherence to therapeutic guidelines in severe community-acquired pneumonia

[Article in English, Spanish]
Simone Gattarello  1 , Sergio Ramírez  1 , José Rafael Almarales  2 , Bárbara Borgatta  1 , Leonel Lagunes  1 , Belén Encina  1 , Jordi Rello  1 ; investigadores del CRIPS
Collaborators, Affiliations

Causes of non-adherence to therapeutic guidelines in severe community-acquired pneumonia

[Article in English, Spanish]
Simone Gattarello et al. Rev Bras Ter Intensiva. 2015 Jan-Mar.

Abstract
in English, Spanish

Objective: To assess the adherence to Infectious Disease Society of America/American Thoracic Society guidelines and the causes of lack of adherence during empirical antibiotic prescription in severe pneumonia in Latin America.

Methods: A clinical questionnaire was submitted to 36 physicians from Latin America; they were asked to indicate the empirical treatment in two fictitious cases of severe respiratory infection: community-acquired pneumonia and nosocomial pneumonia.

Results: In the case of community acquired pneumonia, 11 prescriptions of 36 (30.6%) were compliant with international guidelines. The causes for non-compliant treatment were monotherapy (16.0%), the unnecessary prescription of broad-spectrum antibiotics (40.0%) and the use of non-recommended antibiotics (44.0%). In the case of nosocomial pneumonia, the rate of adherence to the Infectious Disease Society of America/American Thoracic Society guidelines was 2.8% (1 patient of 36). The reasons for lack of compliance were monotherapy (14.3%) and a lack of dual antibiotic coverage against Pseudomonas aeruginosa (85.7%). If monotherapy with an antipseudomonal antibiotic was considered adequate, the antibiotic treatment would be adequate in 100% of the total prescriptions.

Conclusion: The compliance rate with the Infectious Disease Society of America/American Thoracic Society guidelines in the community-acquired pneumonia scenario was 30.6%; the most frequent cause of lack of compliance was the indication of monotherapy. In the case of nosocomial pneumonia, the compliance rate with the guidelines was 2.8%, and the most important cause of non-adherence was lack of combined antipseudomonal therapy. If the use of monotherapy with an antipseudomonal antibiotic was considered the correct option, the treatment would be adequate in 100% of the prescriptions.

Objetivo: Valorar tasa de adherencia y causas de no adherencia a las guías terapéuticas internacionales para la prescripción antibiótica empírica en la neumonía grave en Latinoamérica.

Métodos: Encuesta clínica realizada a 36 médicos de Latinoamérica donde se pedía indicar el tratamiento empírico en 2 casos clínicos ficticios de pacientes con infección respiratoria grave: neumonía adquirida en la comunidad y neumonía nosocomial.

Resultados: En el caso de la neumonía comunitaria el tratamiento fue adecuado en el 30,6% de las prescripciones. Las causas de no adherencia fueron monoterapia (16,0%), cobertura no indicada para multirresistentes (4,0%) y empleo de antibióticos con espectro inadecuado (44,0%). En el caso de la neumonía nosocomial el cumplimiento de las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 2,8%. Las causas de falta de adherencia fueron monoterapia (14,3%) y la falta de doble tratamiento antibiótico frente a Pseudomonas aeruginosa (85,7%). En caso de considerar correcta la monoterapia con actividad frente a P. aeruginosa, el tratamiento sería adecuado en el 100% de los casos.

Conclusión: En la neumonía comunitaria la adherencia a las guías terapéuticas Infectious Disease Society of America/American Thoracic Society fue del 30,6%; la causa más frecuente de incumplimiento fue el uso de monoterapia. La adherencia en el caso de la neumonía nosocomial fue del 2,8% y la causa más importante de incumplimiento fue la falta de doble tratamiento frente a P. aeruginosa, considerando adecuada monoterapia con actividad frente a P. aeruginosa la adherencia sería del 100%.

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Conflict of interest statement

Conflicts of interest: Dr. Rello is a member of the Advisory Board and a Speaker for Pfizer. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Antibiotic regimens most frequently indicated in the case of community-acquired pneumonia.
Figure 2
Figure 2
Antibiotic regimens most frequently indicated in the case of nosocomial pneumonia.
See this image and copyright information in PMC

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