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

被引：58

作者：

Menendez, R. ^{[1
]}

Torres, A. ^{[2
]}

Reyes, S. ^{[1
]}

Zalacain, R. ^{[4
]}

Capelastegui, A. ^{[5
]}

Aspa, J. ^{[6
]}

Borderias, L. ^{[7
]}

Martin-Villasclaras, J. J. ^{[8
]}

Bello, S. ^{[3
,9
]}

Alfageme, I. ^{[10
]}

de Castro, F. R. ^{[11
]}

Rello, J.

Molinos, L. ^{[12
]}

Ruiz-Manzano, J. ^{[13
]}

机构：

[1] Hosp Univ La Fe, Serv Neumol, Valencia, Spain

[2] Univ Barcelona, Serv Pneumol, Inst Clin Torax, IDIBAPS, Ciberes Grs, Spain

[3] Hosp Valle De Hebron, Inst Recerca Vall dHebron UAB, Barcelona, Spain

[4] Hosp Cruces, Serv Neumol, Bilbao, Spain

[5] Hosp Galdakao, Serv Neumol, Galdakao, Spain

[6] Hosp Princesa, Serv Neumol, Madrid, Spain

[7] Hosp San Jorge, Serv Neumol, Huesca, Spain

[8] Hosp Carlos Haya, Serv Neumol, Malaga, Spain

[9] Hosp Miguel Servet, Serv Neumol, Zaragoza, Spain

[10] Hosp Valme, Serv Neumol, Seville, Spain

[11] Hosp Dr Negrin, Serv Neumol, Las Palmas Gran Canaria, Spain

[12] Univ Oviedo, Hosp Cent Asturias, Serv Neumol, E-33080 Oviedo, Spain

[13] Hosp Badalona Germans Trias & Pujol, Serv Neumol, Badalona, Spain

来源：

EUROPEAN RESPIRATORY JOURNAL | 2012年 / 39卷 / 01期

关键词：

Audit; community-acquired pneumonia; compliance; length of stay; mortality; status; COMMUNITY-ACQUIRED-PNEUMONIA; LENGTH-OF-STAY; HOSPITAL STAY; ANTIMICROBIAL THERAPY; ANTIBIOTIC DELIVERY; MEDICARE PATIENTS; PREDICTION RULE; CARE; GUIDELINES; ADULTS;

D O I：

10.1183/09031936.00188710

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

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.

引用

页码：156 / 162

页数：7

共 37 条

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