PURPOSE: The ATS and IDSA have jointly authored treatment guidelines for community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Little data exist regarding guideline compliance and the consequences of non-compliant regimens.
METHODS: We retrospectively reviewed the charts of patients with a discharge ICD-9 code for pneumonia in 2008. We abstracted data regarding pneumonia subtypes, guideline compliance of prescribed therapy, and the reason(s) for guideline noncompliance. Microbiology data were reviewed to assess antibiotic adequacy (at least one prescribed antibiotic had activity against the pathogen isolated) regardless of guideline compliance.
RESULTS: The study cohort included 280 HCAP patients, 161 CAP patients, 42 HAP patients and 40 VAP patients. Microbiology data confirmed infection in 36.1%. Combination therapy rates varied between CAP (44.8%), HCAP (68.5%), HAP (50.0%) and VAP (62.5%, p<0.001). Guideline compliance rates were also varied for CAP (54.7%), HCAP (15.1), HAP (16.7%), and VAP (10.0%, p<0.001). Reasons for guideline noncompliance varied significantly by pneumonia subset (p<0.001). Patients with HCAP, HAP and VAP were more likely to receive therapy which was too narrow (61.4%, 69.0%, and 62.5% respectively) when compared to CAP patients (14.3%). Similarly, patients with HCAP, HAP and VAP were more likely to receive inappropriate doses of antibiotics (34.6%, 47.6%, and 34.0% respectively) when compared to CAP patients (8.7%). Inappropriately broad therapy was more likely in CAP patients (27.3%) compared to HCAP, HAP and VAP patients (7.5%, 2.4%, and 5.0% respectively). Despite high rates of guideline noncompliance, therapy was adequate for the isolated pathogens in 96.3% of CAP patients, 93.9% of HCAP patients, 92.9% of HAP patients, and 90.0% of VAP patients.
CONCLUSION: HCAP was the most commonly encountered pneumonia subtype at this institution. Although rates of guideline-noncompliance were surprisingly high, rates of adequate therapy were at least 90% in all pneumonia subsets.
CLINICAL IMPLICATIONS: Current guideline recommendations may need to be revised in order to avoid over-prescription of antibiotics.
DISCLOSURE: Kyle Bierman, No Financial Disclosure Information; No Product/Research Disclosure Information