OUTCOME OF GUIDELINES COMPLIANCE IN HOSPITALIZED NURSING HOME-ACQUIRED PNEUMONIA

Abstract

PURPOSE: The impact of clinical guidelines on time to clinical stability, length of hospital stay, and mortality among nursing home patients hospitalized for pneumonia has not been previously studied. METHOD(S): Design: A retrospective cohort study. Setting(s): three tertiary hospitals. Participant(s): Three hundred thirty four nursing home patients.Measurements: Patients were classified according to the antibiotic regimens they have received based on either the 2003 community acquired pneumonia (CAP) guideline or the 2005 health-care associated pneumonia (HCAP) guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention to treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups. RESULT(S): Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability was achieved in 3.7+/-0.7 days for the study cohort and did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index (p=0.006) and multilobar involvement (p=0.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (OR 0.87; 95% CI 0.49-1.34, and OR 0.79; 95% CI 0.42-1.31, respectively) although the time to switch therapy and the length of stay were longer for those treated according to the 2005 HCAP guideline. CONCLUSION(S): Among hospitalized nursing home patients with pneumonia, treatment with antibiotic regimen according to 2003 CAP guideline achieved comparable time to clinical stability, and in-hospital and 30-day mortality to a regimen based on 2005 HCAP guideline. CLINICAL IMPLICATIONS: Antibiotic therapy for NHAP may be approached similar to CAP therapy in absence of risk factors for multidrug resistant pathogens.