Initial management of pneumonia and sepsis: factors associated with improved outcome.

Autores de IIS La Fe

• Rosario Menéndez Villanueva

  Autor

• Antonio Torres Marti

  Autor

• Soledad Reyes Calzada

  Autor

• Rafael Zalacain Jorge

  Autor

• Javier Aspa Marco

  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
• de Castro FR

Grupos

• Infecciones Respiratorias

Abstract

Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.