Erwin Beth L, Kyle Jeffrey A, Allen Leland N
Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, AL, USA.
Department of Pharmacy Practice, McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
J Pharm Pract. 2016 Aug;29(4):386-91. doi: 10.1177/0897190014566303. Epub 2015 Jan 19.
The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen.
A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision (ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy.
Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55.
Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP.
2005年美国胸科学会/美国感染病学会（ATS/IDSA）关于医院获得性肺炎（HAP）、呼吸机相关性肺炎（VAP）和医疗保健相关性肺炎（HCAP）的指南强调了及时启动恰当经验性抗生素治疗的重要性。本研究的目的是确定接受基于指南的经验性抗生素治疗的HAP、VAP和HCAP患者的比例，并确定开始使用恰当经验性治疗方案的平均时间。
在阿拉巴马州伯明翰市郊的一家社区医院对患有HAP、VAP或HCAP的成人患者进行回顾性病历审查。该医院的电子病历系统使用国际疾病分类第九版（ICD-9）编码来识别诊断为肺炎的患者。计算接受基于指南的经验性抗生素治疗的患者比例。对于接受基于指南治疗的患者，计算从疑似肺炎诊断到经验性治疗方案中最终抗生素首次给药的平均时间。
93名患者符合纳入标准。经验性抗生素治疗的总体指南依从率为31.2%。基于指南治疗的平均时间（小时：分钟）：HAP为7:47，HCAP为28:16。HAP和HCAP合并计算时，恰当治疗的平均时间为21:55。
与HAP患者相比，HCAP患者的指南依从率较低，开始恰当经验性治疗的时间更长。
