Use of guidelines in treating community-acquired pneumonia

Abstract

Study objectives: Guidelines for empiric treatment of community-acquired pneumonia (CAP) have been developed to assist in prescribing appropriate antimicrobials. We studied utilization of guidelines developed by the American Thoracic, Canadian Infectious Diseases, and Canadian Thoracic Societies (ATS, CIDS, and CTS, respectively), physicians' familiarity with them, reasons that prompt deviation from them, and their effects on clinical outcomes.

Design: Two-part observational study, with prospective and retrospective groups.

Setting: A 1,100-bed, two-campus, tertiary-care teaching hospital.

Patients and participants: Patients admitted to the general medical ward who were being treated empirically for CAP and housestaff who provided their care.

Interventions: Medical residents reported on patients admitted to the hospital with CAP. The charts of all unreported patients admitted with CAP over the same period were reviewed.

Measurements and results: One hundred twenty-two patients were prospectively described and another 130 patients were identified retrospectively. There was no difference in guidelines adherence between the prospective and retrospective groups (81% compared with 80%; p=0.94). Deviation occurred most commonly in suspected aspiration. When physicians believed that they were following guidelines, this was true in 88%. When physicians believed that they were deviating, they were actually adhering in 46%. Guidelines adherence did not alter in-hospital mortality (12% compared with 14%, p=0.92) or length of hospitalization (median, 6 days for both groups).

Conclusions: ATS/CIDS/CTS guidelines for empiric treatment of CAP are widely used in our institution. Future amendments should address aspiration more explicitly. Residents' familiarity with them could be improved. Beneficial effects on outcomes remain unproven.