Adherence to ATS guidelines for hospitalized patients with community-acquired pneumonia

OBJECTIVE: To compare outcomes of care and antibiotic utilization for community-acquired pneumonia (CAP) throughout a group of not-for-profit hospitals. METHODS: A retrospective chart review of patients from community hospitals with a diagnosis of pneumonia at discharge admitted from December 1997 to May 1998. Data were collected based on American Thoracic Society (ATS) criteria. RESULTS: Medical records of 330 patients were reviewed; mortality was 7%. Using ATS guidelines, 51 (15.5%) patients were not treated with recommended antimicrobial therapy. Of these patients, 14 had nonsevere cases of CAP and 37 cases were severe. Factors found to be associated with in-hospital mortality included nonadherence to ATS guidelines (OR 4.46; 95% CI 1.38 to 14.43), decreased urine output (OR 7.72; 95% CI 1.70 to 35.04), and increasing age (OR 1.06; 95% Cl 1.01 to 1.12). Significant predictors of length of stay (LOS) included age, nonadherence to ATS criteria, suspected aspiration, discharge status, low pulse oximetry on admission, decreased urine output, use of vasopressor medications, and interstitial lung disease. More than 80% of patients had at least one culture performed, but only 27.5% of these cultures were positive. The most commonly prescribed antibiotic was cefuroxime injection, representing 25% of the antibiotic orders. CONCLUSIONS: Patients with CAP treated inconsistently with ATS guidelines had a 4.46-fold higher risk of inpatient mortality and had significantly longer LOS.