Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs.

Autores de IIS La Fe

• Rosario Menéndez Villanueva

  Autor

• Antonio Torres Marti

  Autor

• Soledad Reyes Calzada

  Autor

• Rafael Zalacain Jorge

  Autor

• Luis Borderias Clau

  Autor

• Juan Jose Martin Villasclaras

  Autor

• Salvador Bello Dondra

  Autor

• Inmaculada Alfageme Michavilla

  Autor

• Jordi Rello Condomines

  Autor

• Luis Molinos Martin

  Autor

• Juan Ruiz Manzano

  Autor

Participantes ajenos a IIS La Fe

• Capelastegui A
• Rajas O
• de Castro FR

Grupos

• Infecciones Respiratorias

Abstract

Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose <6 hours and oxygen assessment. Antibiotic adherence was 72.6%, first dose <6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence was negatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia =100 bpm (OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment was negatively associated with fever (OR, 0.61), whereas tachypnea =30 (OR, 1.58), tachycardia (OR, 1.39), age >65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.