Raffaella Rossio1, Carlotta Franchi2, Ilaria Ardoino3, Codjo D Djade4, Mauro Tettamanti4, Luca Pasina4, Francesco Salerno5, Alessandra Marengoni6, Salvatore Corrao7, Maura Marcucci8, Flora Peyvandi1, Elia M Biganzoli3, Alessandro Nobili4, Pier Mannuccio Mannucci9. 1. Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. 2. Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: carlotta.franchi@marionegri.it. 3. Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy. 4. Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. 5. Department of Medical and Surgery Sciences, IRCCS Policlinico San Donato, University of Milan, Italy. 6. Department of Clinical and Experimental Science, University of Brescia, Italy. 7. Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy. 8. Geriatrics Unit, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. 9. Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Policlinico Foundation, Milan, Italy.
Abstract
BACKGROUND: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). METHODS: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. RESULTS: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. CONCLUSIONS: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.
BACKGROUND: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). METHODS: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. RESULTS: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. CONCLUSIONS: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.
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