Skip to main content Accessibility help
×
Home

Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia

  • M. A. Fernandez-Sierra (a1), M. T. Rueda-Domingo (a1), M. M. Rodriguez-del-Aguila (a1), M. J. Perez-Lozano (a2), L. Force (a3), T. Fernandez-Villa (a4), J. Astray (a5), M. Egurrola (a6), J. Castilla (a7) (a8), F. Sanz (a9), D. Toledo (a8) (a10), A. Dominguez (a8) (a10) and Workgroup Project PI12/02079 (a1) (a2) (a3) (a4) (a5) (a6) (a7) (a8) (a9) (a10)...

Abstract

Early, conforming antibiotic treatment in elderly patients hospitalised for community-acquired pneumonia (CAP) is a key factor in the prognosis and mortality. The objective was to examine whether empirical antibiotic treatment was conforming according to the Spanish Society of Pulmonology and Thoracic Surgery guidelines in these patients. Multicentre study in patients aged ⩾65 years hospitalised due to CAP in the 2013–14 and 2014–15 influenza seasons. We collected socio-demographic information, comorbidities, influenza/pneumococcal vaccination history and antibiotics administered using a questionnaire and medical records. Bivariate analyses and multilevel logistic regression were made. In total, 1857 hospitalised patients were included, 82 of whom required intensive care unit (ICU) admission. Treatment was conforming in 51.4% (95% confidence interval (CI) 49.1–53.8%) of patients without ICU admission and was associated with absence of renal failure without haemodialysis (odds ratio (OR) 1.49, 95% CI 1.15–1.95) and no cognitive dysfunction (OR 1.71, 95% CI 1.25–2.35), when the effect of the autonomous community was controlled for. In patients with ICU admission, treatment was conforming in 45.1% (95% CI 34.1–56.1%) of patients and was associated with the hospital visits in the last year (<3 vs. ⩾3, OR 2.70, 95% CI 1.03–7.12) and there was some evidence that this was associated with season. Although the reference guidelines are national, wide variability between autonomous communities was found. In patients hospitalised due to CAP, health services should guarantee the administration of antibiotics in a consensual manner that is conforming according to clinical practice guidelines.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Adaptation of antibiotic treatment to clinical practice guidelines in patients aged ⩾65 years hospitalised due to community-acquired pneumonia
      Available formats
      ×

Copyright

Corresponding author

Author for correspondence: M. M. Rodriguez-del-Aguila, E-mail: mmar.rodriguez.sspa@juntadeandalucia.es

References

Hide All
1.Torres, A et al. (2013) Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax 68, 10571065.
2.Rivero-Calle, et al. (2016) Incidence and risk factor prevalence of community-acquired pneumonia in adults in primary care in Spain (NEUMO-ES-RISK project). BMC Infectious Diseases 16, 645.
3.Petrosillo, N, Cataldo, MA and Pea, F (2015) Treatment options for community-acquired pneumonia in the elderly people. Expert Review of Antiinfective Therapy 13, 473485.
4.de Miguel-Díez, J et al. (2017) Trends in hospitalizations for community-acquired pneumonia in Spain: 2004 to 2013. European Journal of Internal Medicine 40, 6471.
5.Mandell, LA et al. (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clinical Infectious Diseases 44, S27S72.
6.Menéndez, R et al. (2010) Neumonía adquirida en la comunidad. Nueva normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Archivos de Bronconeumología 46, 543558.
7.Gutiérrez, F et al. (2005) Epidemiology of community-acquired pneumonia in adult patients at the dawn of the 21st century: a prospective study on the Mediterranean coast of Spain. Clinical Microbiology and Infection 11, 788800.
8.Cruzeta, APS, Schneider, IJC and Traebert, J (2013) Impact of seasonality and annual immunization of elderly people upon influenza-related hospitalization rates. International Journal of Infectious Diseases 17, e1194e1197.
9.Tomczyk, S et al. (2014) Use of 13valent pneumococcal conjugate vaccine and 23valent pneumococcal polysaccharide vaccine among adults aged ⩾65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity and Mortality Weekly Report 63, 822.
10.Centers for Disease Control and Prevention (2012) Use of 13valent pneumococcal conjugate vaccine and 23valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity and Mortality Weekly Report 61, 816.
11.Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices (2010) Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morbidity and Mortality Weekly Report 59, 1102.
12.Bonten, MJ, Huijts, SM and Bolkenbaas, M (2015) Vaccine against pneumococcal pneumonia in adults. The New England Journal of Medicine 373, 9193.
13.Domínguez, A et al. (2010) Effectiveness of the pneumococcal polysaccharide vaccine in preventing pneumonia in the elderly. The European Respiratory Journal 36, 608614.
14.Lim, WS et al. (2009) BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 64, iii155.
15.Woodhead, M et al. (2011) Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Clinical Microbiology and Infection 17, E159.
16.Robinson, HL, Robinson, PC and Whitby, M (2014) Poor compliance with community-acquired pneumonia antibiotic guidelines in a large Australian private hospital emergency department. Microbial Drug Resistance 20, 561567.
17.Rossio, R et al. (2015) Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia. European Journal of Internal Medicine 26, 330337.
18.Uranga, A et al. (2016) Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA Internal Medicine 176: 12571265.
19.Eccles, S et al. (2014) Diagnosis and management of community and hospital acquired pneumonia in adults: summary of NICE guidance. British Medical Journal 349, g6722.
20.Postma, DF et al. (2015) For the CAP-START Study Group. Antibiotic treatment strategies for community-acquired pneumonia in adults. The New England Journal of Medicine 372, 13121323.
21.van Werkhoven, CH, Postma, DF and Bonten, MJ (2015) Antibiotics for community-acquired pneumonia in adults. The New England Journal of Medicine 373, 7.
22.Levy, G. et al. (2015) Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: resultados del Estudio CAPO en Venezuela. Archivos de Bronconeumología 51, 163168.
23.Galván-Banqueri, M et al. (2014) Factors related with the appropriateness of pharmacological treatment in polypathological patients. Farmacia Hospitalaria 38, 405410.
24.Fernández-Urrusuno, R et al. (2014) Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal. Enfermedades Infecciosas y Microbiología Clínica 32, 285292.
25.Pérez-Fuentes, MF et al. (2002) Adecuación del tratamiento farmacológico en población anciana polimedicada. Medicina de Familia (Andalucía) 3, febrero 2002, 2328.
26.Xiangru, Y et al. (2015) Improvement in clinical and economic outcomes with empiric antibiotic therapy covering atypical pathogens for community-acquired pneumonia patients: a multicenter cohort study. International Journal of Infectious Diseases 40, 102107.
27.Torres, A et al. (2013) Multidisciplinary guidelines for the management of community-acquired pneumonia. Medicina Clínica 140, 223, e1–223.e19.
28.Pachón, J et al. (2009) Sociedad Andaluza de Enfermedades Infecciosas (SAEI); Sociedad Andaluza de Medicina Familiar y Comunitaria (SAMFYC). Clinical management of community-acquired pneumonia in adults. Medicina Clínica 133, 6373.
29.Guiasalud.es. Biblioteca de Guias de Practica Clinica del Sistema Nacional de Salud. Available at http://portal.guiasalud.es/web/guest/guias-practica-clinica (Accessed 20 July 2018).
30.Berger, A et al. (2014) Patterns of initial antibiotic therapy for community-acquired pneumonia in U.S. Hospitals, 2000 to 2009. The American Journal of the Medical Sciences 347, 347356.
31.Pradelli, J et al. (2015) Community-acquired pneumonia: impact of empirical antibiotic therapy without respiratory fluoroquinolones nor third-generation cephalosporins. European Journal of Clinical Microbiology and Infectious Diseases 34, 511518.
32.Wang, CC et al. (2016) Comparative outcome analysis of penicillin-based versus fluoroquinolone-based antibiotic therapy for community-acquired pneumonia. A nationwide population-based cohort study. Medicine (Baltimore) 95, e2763.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed