The impact of adherence to community-acquired pneumonia (CAP) management guidelines on improving clinical outcomes in hospitalized patients
Main Article Content
Keywords
Community-acquired pneumonia (CAP), Cohort study, Adherence, Jordan
Abstract
Objectives: Community-acquired pneumonia (CAP) is linked with high morbidity and mortality, particularly among the elderly. Because of the high incidence and accompanying financial expenses, accurate diagnosis and adequate care of this group hospitalized with CAP are required. The purpose of the study was to assess the level of adherence to CAP national guidelines at a private hospital, as well as the impact of adherence to these national recommendations on clinical outcomes. Methods: Data from electronic medical records of adult patients hospitalized with CAP between 2018 and 2019 were retrieved for a quantitative observational retrospective cohort research. Results: This study comprised 159 patients, with 76 patients (47.8%) receiving therapy according to the recommendations of the guidelines. A total of 75 (98.7%) of those patients were hospitalized across the ICU wards. In contrast, 98.4% (64/65) of patients who had received empiric antibiotic treatment within isolation floors were non-compliant. There was a statistically significant relationship between the level of adherence to CAP clinical guidelines and the following variables: The 72-hour reassessment (P = 0.01), medications altered OR retained when culture findings were revealed (P = 0.01), primary diagnosis (P = 0.028), and total intended period of antibiotic therapy (P = 0.007). Conclusions: According to the findings of this study, higher adherence to the guidelines amongst ICU patients was linked to better outcomes, such as a significant reduction in the overall planned period of antibiotic therapy
References
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doi.org/10.1136/thx.2008.109785
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28. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America, American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired
pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-72. https://doi.org/10.1086/511159
29. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386(9998):1097-1108. https://doi.org/10.1016/S0140-6736(15)60733-4
30. Quan TP, Fawcett NJ, Wrightson JM, et al. Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014. Thorax. 2016;71(6):535-542. https://doi.org/10.1136/thoraxjnl-2015-207688
31. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313(7):677-750.
https://doi.org/10.1001/jama.2015.88
32. Tschernig T. Hospital-acquired pneumonia and community-acquired pneumonia: two guys? Annals of Translational Medicine. 2016;4(S1):S22. https://doi.org/10.21037/atm.2016.10.10
33. Yu H, Rubin J, Dunning S, et al. Clinical and economic burden of community-acquired pneumonia in the Medicare fee-forservice population. J Am Geriatr Soc. 2012;60(11):2137-2180. https://doi.org/10.1111/j.1532-5415.2012.04208
34. Chalmers J, Campling J, Ellsbury G, et al. Community-acquired pneumonia in the United Kingdom: a call to action. Pneumonia (Nathan). 2017;5(9):15. https://doi.org/10.1186/s41479-017-0039-9
35. Bosso JA, Drew RH. Application of antimicrobial stewardship to optimize management of community-acquired pneumonia. Int J Clin Pract. 2011;65(7):775-851. https://doi.org/10.1111/j.1742-1241.2011.02704.x
36. Sharma R, Sandrock CE, Meehan J, et al. Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin. Clin Drug Investig. 2020;40(10):947-960. https://doi.org/10.1007/
s40261-020-00953-z
37. Brown JS. Community-acquired pneumonia. Clin Med (Lond). 2012;12(6):538-543. https://doi.org/10.7861/clinmedicine.12-6-538
38. Foolad F, Huang AM, Nguyen CT. A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia. J Antimicrob Chemother. 2018;73(5):1402-1407. https://doi.org/10.1093/
jac/dky021
39. Kurtzhalts KE, Sellick JA Jr, Ruh CA, et al. Impact of Antimicrobial Stewardship on Outcomes in Hospitalized Veterans with Pneumonia. Clin Ther. 2016;38(7):1750-1758. https://doi.org/10.1016/j.clinthera.2016.06.004
40. Grenier C, Pépin J, Nault V. Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community-acquired pneumonia. J Antimicrob Chemother. 2011;66(7):1617-1624. https://doi.org/10.1093/jac/dkr176
41. Fésüs A, Benkő R, Matuz M, et al. Impact of Guideline Adherence on Outcomes in Patients Hospitalized with CommunityAcquired Pneumonia (CAP) in Hungary: A Retrospective Observational Study. Antibiotics. 2022;11(4):468. https://doi.
org/10.3390/antibiotics11040468
42. Sharma R, Sandrock CE, Meehan J, et al. Community-Acquired Bacterial Pneumonia-Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin [published correction appears in Clin Drug Investig. 2021 Feb;41(2):197]. Clin
Drug Investig. 2020;40(10):947-960. https://doi.org/10.1007/s40261-020-00953-z
43. Lutfiyya MN, Henley E, Chang LF, et al. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73(3):442-450
2. Brown PD. Adherence to guidelines for community-acquired pneumonia: does it decrease cost of care? Pharmacoeconomics. 2004;22(7):413-433. https://doi.org/10.2165/00019053-200422070-00001
3. Triantafyllidis C, Kapordelis V, Papaetis GS, et al. Guidelines adherence for patients with community acquired pneumonia in a Greek hospital. Eur Rev Med Pharmacol Sci. 2012;16(1):1-9.
4. Kolditz M, Ewig S. Community-Acquired Pneumonia in Adults. Dtsch Arztebl Int. 2017;114(49):838-848. https://doi.org/10.3238/arztebl
5. Watkins RR, Lemonovich TL. Diagnosis and management of community-acquired pneumonia in adults. Am Fam Physician. 2011;83(11):1299-1306.
6. Christensen D, Luna CM, Martínez J, et al. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad. Resultados del estudio CAPO en Argentina [Adherence with national guidelines in hospitalized
patients with community-acquired pneumonia. Results of CAPO study in Argentina]. Medicina (B Aires). 2007;67(6 Pt 2):709-722.
7. Levy G, Perez M, Rodríguez B, et al. Adherence with national guidelines in hospitalized patients with community-acquired pneumonia: results from the CAPO study in Venezuela. Arch Bronconeumol. 2015;51(4):163-168. https://doi.org/10.1016/j.
arbres
8. Corrêa Rde A, Lundgren FL, Pereira-Silva JL, et al. Comissão de Infecções Respiratórias e Micoses - Sociedade Brasileira de Pneumologia e Tisiologia. Brazilian guidelines for community-acquired pneumonia in immunocompetent adults - 2009. J Bras
Pneumol. 2009;35(6):574-601. https://doi.org/10.1590/s1806-37132009000600011
9. Feldman C, Anderson R. Community-Acquired Pneumonia: Pathogenesis of Acute Cardiac Events and Potential Adjunctive Therapies. Chest. 2015;148(2):523-532. https://doi.org/10.1378/chest.15-0484
10. Ferreira HLDS, Costa KLP, Cariolano MS, et al. High incidence of rhinovirus infection in children with community-acquired pneumonia from a city in the Brazilian pre-Amazon region. J Med Virol. 2019;91(10):1751-1758. https://doi.org/10.1002/
jmv.25524
11. Lanks CW, Musani AI, Hsia DW. Community-acquired Pneumonia and Hospital-acquired Pneumonia. Med Clin North Am. 2019;103(3):487-501. https://doi.org/10.1016/j.mcna.2018.12.008
12. Mantero M, Tarsia P, Gramegna A, et al. Antibiotic therapy, supportive treatment and management of immunomodulationinflammation response in community acquired pneumonia: review of recommendations. Multidiscip Respir Med. 2017;5(12):26.
https://doi.org/10.1186/s40248-017-0106-3
13. Schnoor M, Hedicke J, Dalhoff K, et al. Approaches to estimate the population-based incidence of community acquired pneumonia. J Infect. 2007;55(3):233-242. https://doi.org/10.1016/j.jinf.2007.04.355
14. Thomas CP, Ryan M, Chapman JD, et al. Incidence and cost of pneumonia in medicare beneficiaries. Chest. 2012;142(4):973-981. https://doi.org/10.1378/chest.11-1160
15. Micek ST, Kollef KE, Reichley RM, et al. Health care-associated pneumonia and community-acquired pneumonia: a singlecenter experience. Antimicrob Agents Chemother. 2007;51(10):3568-3640. https://doi.org/10.1128/AAC.00851-07
16. Ramirez JA, Anzueto AR. Changing needs of community-acquired pneumonia. Journal of Antimicrobial Chemotherapy. 2011;66(3):3-9. https://doi.org/10.1093/jac/dkr094
17. Rozenbaum MH, Pechlivanoglou P, van der Werf TS, et al. The role of Streptococcus pneumoniae in community-acquired pneumonia among adults in Europe: a meta-analysis. Eur J Clin Microbiol Infect Dis. 2013;32(3):305-321. https://doi.
org/10.1007/s10096-012-1778-4
18. von Baum H, Schweiger B, Welte T, et al. How deadly is seasonal influenza-associated pneumonia? The German Competence Network for Community-Acquired Pneumonia. Eur Respir J. 2011;37(5):1151-7. https://doi.org/10.1183/09031936.00037410
19. Wunderink RG, Waterer G. Advances in the causes and management of community acquired pneumonia in adults. BMJ. 2017;358-372. https://doi.org/10.1136/bmj. j2471
20. Bosso JA, Drew RH. Application of antimicrobial stewardship to optimise management of community acquired pneumonia. International Journal of Clinical Practice. 2011;65(7):775-783. https://doi.org/10.1111/j.1742-1241.2011.02704.x
21. Silveira CD, Ferreira CS, Corrêa Rde A. Adherence to guidelines and its impact on outcomes in patients hospitalized with community-acquired pneumonia at a university hospital. J Bras Pneumol. 2012;38(2):148-207. https://doi.org/10.1590/
s1806-37132012000200002
22. Blasi F, Garau J, Medina J, et al. Current management of patients hospitalized with community-acquired pneumonia across Europe: outcomes from REACH. Respir Res. 2013;14(1):44. https://doi.org/10.1186/1465-9921-14-44
23. Bantar C, Bavestrello L, Curcio D, et al. Acute community-acquired pneumonia in adults: guidelines for initial antimicrobial therapy based on local evidence from a South American Working Group (ConsenSur). J Chemother. 2002;14 (Suppl 4):1-22.
https://doi.org/10.1080/1120009x.2002.11782352
24. Ewig S, Birkner N, Strauss R, et al. New perspectives on community-acquired pneumonia in 388 406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax. 2009;64(12):1062-1071. https://
doi.org/10.1136/thx.2008.109785
25. Lim TK, Chew MY. Management of severe community acquired pneumonia in the emergency department. Journal of Emergency and Critical Care Medicine. 2018;2(2):2-4. https://doi.org/10.21037/jeccm.2017.12.12
26. Lim WS, Baudouin SV, George RC, et al. Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):1-55.
https://doi.org/10.1136/thx.2009.121434
27. Lutfiyya MN, Henley E, Chang LF, et al. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73(3):442-450.
28. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America, American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired
pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-72. https://doi.org/10.1086/511159
29. Prina E, Ranzani OT, Torres A. Community-acquired pneumonia. Lancet. 2015;386(9998):1097-1108. https://doi.org/10.1016/S0140-6736(15)60733-4
30. Quan TP, Fawcett NJ, Wrightson JM, et al. Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014. Thorax. 2016;71(6):535-542. https://doi.org/10.1136/thoraxjnl-2015-207688
31. Torres A, Sibila O, Ferrer M, et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA. 2015;313(7):677-750.
https://doi.org/10.1001/jama.2015.88
32. Tschernig T. Hospital-acquired pneumonia and community-acquired pneumonia: two guys? Annals of Translational Medicine. 2016;4(S1):S22. https://doi.org/10.21037/atm.2016.10.10
33. Yu H, Rubin J, Dunning S, et al. Clinical and economic burden of community-acquired pneumonia in the Medicare fee-forservice population. J Am Geriatr Soc. 2012;60(11):2137-2180. https://doi.org/10.1111/j.1532-5415.2012.04208
34. Chalmers J, Campling J, Ellsbury G, et al. Community-acquired pneumonia in the United Kingdom: a call to action. Pneumonia (Nathan). 2017;5(9):15. https://doi.org/10.1186/s41479-017-0039-9
35. Bosso JA, Drew RH. Application of antimicrobial stewardship to optimize management of community-acquired pneumonia. Int J Clin Pract. 2011;65(7):775-851. https://doi.org/10.1111/j.1742-1241.2011.02704.x
36. Sharma R, Sandrock CE, Meehan J, et al. Community-Acquired Bacterial Pneumonia—Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin. Clin Drug Investig. 2020;40(10):947-960. https://doi.org/10.1007/
s40261-020-00953-z
37. Brown JS. Community-acquired pneumonia. Clin Med (Lond). 2012;12(6):538-543. https://doi.org/10.7861/clinmedicine.12-6-538
38. Foolad F, Huang AM, Nguyen CT. A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia. J Antimicrob Chemother. 2018;73(5):1402-1407. https://doi.org/10.1093/
jac/dky021
39. Kurtzhalts KE, Sellick JA Jr, Ruh CA, et al. Impact of Antimicrobial Stewardship on Outcomes in Hospitalized Veterans with Pneumonia. Clin Ther. 2016;38(7):1750-1758. https://doi.org/10.1016/j.clinthera.2016.06.004
40. Grenier C, Pépin J, Nault V. Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community-acquired pneumonia. J Antimicrob Chemother. 2011;66(7):1617-1624. https://doi.org/10.1093/jac/dkr176
41. Fésüs A, Benkő R, Matuz M, et al. Impact of Guideline Adherence on Outcomes in Patients Hospitalized with CommunityAcquired Pneumonia (CAP) in Hungary: A Retrospective Observational Study. Antibiotics. 2022;11(4):468. https://doi.
org/10.3390/antibiotics11040468
42. Sharma R, Sandrock CE, Meehan J, et al. Community-Acquired Bacterial Pneumonia-Changing Epidemiology, Resistance Patterns, and Newer Antibiotics: Spotlight on Delafloxacin [published correction appears in Clin Drug Investig. 2021 Feb;41(2):197]. Clin
Drug Investig. 2020;40(10):947-960. https://doi.org/10.1007/s40261-020-00953-z
43. Lutfiyya MN, Henley E, Chang LF, et al. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73(3):442-450
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Sep 27, 2023
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The impact of adherence to community-acquired pneumonia (CAP) management guidelines on improving clinical outcomes in hospitalized patients. Pharm Pract (Granada) [Internet]. 2023 Sep. 27 [cited 2024 Apr. 30];21(3):1-7. Available from: https://pharmacypractice.org/index.php/pp/article/view/2844
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