Community-acquired pneumonia at the Hospital de Clínicas de Porto Alegre: evaluation of a care protocol.

Abstract

To assess the adequacy of medical prescriptions for community-acquired pneumonia at the emergency department of the Hospital de Clínicas de Porto Alegre, we conducted a prospective cohort study, from January through April 2011. All patients with suspected pneumonia were selected from the first prescription of antimicrobials held in the emergency room. Patients with a description of pneumonia, community-acquired pneumonia, respiratory infection, or other issues related to community-acquired pneumonia were selected for review. Two-hundred and fifteen patients were studied. Adherence to the hospital care protocol was: 11.2% for the initial recommended tests (chest X-ray and collection of sputum sample), 34.4% for blood cultures, and 92.1% for the antimicrobial choice. Sixty percent of the prescriptions consisted of a combination of drugs, and the association of beta-lactam and macrolide was the most common. The Hospital Infection Control Committee evaluated patients' prescriptions within a median time of 23.5h (IQR 25-75%, 8-24). Negative evaluations accounted for 10% of prescriptions (n=59). Fourteen percent of the patients died during hospitalization. In the multivariate analysis, Pneumonia Severity Index Score and use of ampicillin+sulbactam alone were independently related to in-hospital mortality. There was a high adherence to the hospital's CAP protocol, in relation to antimicrobial choice. Severity score and use of ampicillin+sulbactam alone were independently associated to in-hospital death.

• Authors: Clei Angelo Mocelin, Rodrigo Pires dos Santos
• Journal: The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (Braz J Infect Dis) 2013 Sep-Oct Vol. 17 Issue 5 Pg. 511-5 ISSN: 1678-4391 [Electronic] Brazil
• PMID: 23830053 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Aged
• Anti-Bacterial Agents (administration & dosage)
• Cohort Studies
• Community-Acquired Infections (diagnosis, drug therapy, mortality)
• Female
• Guideline Adherence
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Pneumonia, Bacterial (diagnosis, drug therapy, mortality)
• Prospective Studies
• Severity of Illness Index