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* From the Pneumology Service, University Hospital La Fe, Valencia, Spain.
Correspondence to: Rosario Menéndez, MD, Servicio de Neumología, Hospital Universitario La Fe, Valencia 46009, Spain
Study objectives: Consensus guidelines for the empirical treatment of community-acquired pneumonia (CAP) have been published. We investigated the following factors: (1) the degree of adherence to American Thoracic Society (ATS) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) guidelines; and (2) the influence of adhering to these guidelines on mortality and length of hospitalization.
Design: Prospective, observational study.
Setting: Tertiary-care teaching hospital.
Patients: Two hundred ninety-five patients with CAP who were consecutively admitted to the hospital and treated empirically.
Interventions: Patients were stratified according to the prognostic rule of Fine, and the antibiotic regimen prescribed in the first 24 h was evaluated as to whether or not it adhered to treatment guidelines.
Results: Adherence to SEPAR and ATS guidelines was 66% and 88%, respectively. There were no significant differences in mortality or duration of hospitalization between adherent and nonadherent regimens. However, mortality in severe CAP (Fine risk class V) was significantly higher in patients with nonadherent treatments (SEPAR: relative risk [RR], 2.6; 95% confidence interval [CI], 1.1 to 5.6; ATS: RR, 2.5; 95% CI, 1.1 to 5.8). In a multivariate analysis, adherence to ATS guidelines was independently associated with decreased mortality (RR, 0.3; 95% CI, 0.14 to 0.9) after adjusting for the Fine score.
Conclusions: Adherence was higher to ATS guidelines than to SEPAR guidelines. Severe CAP had a significantly higher mortality when the guidelines (both ATS and SEPAR) were not followed. Length of hospitalization was similar irrespective of adherence to either set of guidelines.
Key Words: community-acquired pneumonia • guidelines • length of hospital stay • mortality • prognosis • treatment
This article has been cited by other articles:
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  R. Menendez and A. Torres Treatment Failure in Community-Acquired Pneumonia Chest, October 1, 2007; 132(4): 1348 - 1355. [Abstract] [Full Text] [PDF]
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 D. Aujesky and M. J. Fine Does Guideline Adherence for Empiric Antibiotic Therapy Reduce Mortality in Community-acquired Pneumonia? Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 655 - 656. [Full Text] [PDF]
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R. Menendez, A. Torres, R. Zalacain, J. Aspa, J. J. Martin-Villasclaras, L. Borderias, J. M. Benitez-Moya, J. Ruiz-Manzano, F. R. de Castro, J. Blanquer, et al. Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 757 - 762. [Abstract] [Full Text] [PDF]
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 R Menendez, A Torres, R Zalacain, J Aspa, J J Martin Villasclaras, L Borderias, J M Benitez Moya, J Ruiz-Manzano, F Rodriguez de Castro, J Blanquer, et al. Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome Thorax, November 1, 2004; 59(11): 960 - 965. [Abstract] [Full Text] [PDF]
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 R. Menendez, M.J. Cremades, E. Martinez-Moragon, J.J. Soler, S. Reyes, and M. Perpina Duration of length of stay in pneumonia: influence of clinical factors and hospital type Eur. Respir. J., October 1, 2003; 22(4): 643 - 648. [Abstract] [Full Text] [PDF]
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