The impact of compliance with Italian guidelines on the outcome of hospitalised community-acquired pneumonia (CAP) in internal medicine departments was evaluated. All Fine class IV or V CAP patients were included in this multicentre, interventional, before-and-after study, composed of three phases: 1) a retrospective phase (RP; 1,443 patients); 2) a guideline implementation phase; and 3) a prospective phase (PP; 1,404 patients). Antibiotic prescription according to the guidelines increased significantly in the PP. The risk of failure at the end of the firstline therapy was significantly lower in the PP versus the RP (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.69-1.00), particularly in Fine class V patients (OR 0.71, 95% CI 0.51-0.98). Analysis of outcome in the overall population (2,847 patients) showed a statistically significant advantage for compliant versus noncompliant therapies in terms of failure rate (OR 0.74, 95% CI 0.60-0.90) and an advantage in terms of mortality (OR 0.77, 95% CI 0.58-1.04). Antipneumococcal cephalosporin monotherapy was associated with a low success rate (68.6%) and the highest mortality (16.2%); levofloxacin alone and the combination of cephalosporin and macrolide resulted in higher success rates (79.1 and 76.7%, respectively) and significantly lower mortalities (9.1 and 5.7%, respectively). Overall, a low compliance with guidelines in the prospective phase (44%) was obtained, indicating the need for future more aggressive and proactive approaches.
Can CAP Guideline Adherence Improve Patient Outcome in Internal Medicine Departments? / F.B.A. Blasi, I. Iori, A. Bulfoni, S. Corrao, S. Costantino, D. Legnani. - In: EUROPEAN RESPIRATORY JOURNAL. - ISSN 0903-1936. - 32:4(2008), pp. 902-910.
|Titolo:||Can CAP Guideline Adherence Improve Patient Outcome in Internal Medicine Departments?|
BLASI, FRANCESCO BRUNO ARTURO (Primo)
LEGNANI, DELFINO (Ultimo)
|Parole Chiave:||Antibiotic; Community-acquired pneumonia; Guidelines|
|Settore Scientifico Disciplinare:||Settore MED/09 - Medicina Interna|
Settore MED/10 - Malattie dell'Apparato Respiratorio
|Data di pubblicazione:||2008|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1183/09031936.00092607|
|Appare nelle tipologie:||01 - Articolo su periodico|