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Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules.
Arch Intern Med. 2009 Sep 14; 169(16):1525-31.AI

Abstract

BACKGROUND

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment, formulated jointly by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS), remain controversial and inconsistently applied. We evaluated the impact of guideline-concordant therapy on in-hospital survival and other outcomes using a large database including adults treated for CAP in both community and tertiary care hospitals.

METHODS

We evaluated the association between in-hospital survival and guideline-concordant therapy using logistic regression models. Time until discharge from hospital and discontinuation of parenteral therapy were evaluated using survival analysis.

RESULTS

Of 54 619 non-intensive care unit inpatients with CAP hospitalized at 113 community hospitals and tertiary care centers, 35 477 (65%) received initial guideline-concordant therapy. After adjustment for severity of illness and other confounders, guideline-concordant therapy was associated with decreased in-hospital mortality (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.63-0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal failure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length of stay and duration of parenteral therapy by approximately 0.6 days (P < .001 for both comparisons). These findings were robust with alternate definitions of "concordance" and were linked to treatment with fluoroquinolone or macrolide agents.

CONCLUSIONS

Guideline-concordant therapy for CAP is associated with improved health outcomes and diminished resource use in adults. The mechanisms underlying this finding remain speculative and warrant further study, but our findings nonetheless support compliance with CAP clinical practice guidelines as a benchmark of quality of care.

Authors+Show Affiliations

Research Institute of the Hospital for Sick Children, Toronto, ON M5G 1E2, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19752411

Citation

McCabe, Caitlin, et al. "Guideline-concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-acquired Pneumonia: Playing By the Rules." Archives of Internal Medicine, vol. 169, no. 16, 2009, pp. 1525-31.
McCabe C, Kirchner C, Zhang H, et al. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med. 2009;169(16):1525-31.
McCabe, C., Kirchner, C., Zhang, H., Daley, J., & Fisman, D. N. (2009). Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Archives of Internal Medicine, 169(16), 1525-31. https://doi.org/10.1001/archinternmed.2009.259
McCabe C, et al. Guideline-concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-acquired Pneumonia: Playing By the Rules. Arch Intern Med. 2009 Sep 14;169(16):1525-31. PubMed PMID: 19752411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. AU - McCabe,Caitlin, AU - Kirchner,Cheryl, AU - Zhang,Huiling, AU - Daley,Jennifer, AU - Fisman,David N, PY - 2009/9/16/entrez PY - 2009/9/16/pubmed PY - 2009/10/3/medline SP - 1525 EP - 31 JF - Archives of internal medicine JO - Arch Intern Med VL - 169 IS - 16 N2 - BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Clinical practice guidelines for empirical CAP treatment, formulated jointly by the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS), remain controversial and inconsistently applied. We evaluated the impact of guideline-concordant therapy on in-hospital survival and other outcomes using a large database including adults treated for CAP in both community and tertiary care hospitals. METHODS: We evaluated the association between in-hospital survival and guideline-concordant therapy using logistic regression models. Time until discharge from hospital and discontinuation of parenteral therapy were evaluated using survival analysis. RESULTS: Of 54 619 non-intensive care unit inpatients with CAP hospitalized at 113 community hospitals and tertiary care centers, 35 477 (65%) received initial guideline-concordant therapy. After adjustment for severity of illness and other confounders, guideline-concordant therapy was associated with decreased in-hospital mortality (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.63-0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal failure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length of stay and duration of parenteral therapy by approximately 0.6 days (P < .001 for both comparisons). These findings were robust with alternate definitions of "concordance" and were linked to treatment with fluoroquinolone or macrolide agents. CONCLUSIONS: Guideline-concordant therapy for CAP is associated with improved health outcomes and diminished resource use in adults. The mechanisms underlying this finding remain speculative and warrant further study, but our findings nonetheless support compliance with CAP clinical practice guidelines as a benchmark of quality of care. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19752411/Guideline_concordant_therapy_and_reduced_mortality_and_length_of_stay_in_adults_with_community_acquired_pneumonia:_playing_by_the_rules_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2009.259 DB - PRIME DP - Unbound Medicine ER -