Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
Eur J Intern Med. 2015 Jun;26(5):330-7. doi: 10.1016/j.ejim.2015.04.002. Epub 2015 Apr 18.
Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older).
Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models.
A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality.
The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.
很少有研究评估社区获得性肺炎（CAP）、医院获得性肺炎（HAP）和与卫生保健相关的肺炎（HCAP）与住院老年人（65 岁或以上）中抗生素治疗对美国传染病学会（IDSA）和美国胸科学会（ATS）指南的依从性的临床结局之间的关系。
数据来自 REPOSI，这是在意大利 87 个内科和老年病房进行的前瞻性登记研究。选择诊断为肺炎（ICD-9 480-487）或因肺炎而开抗生素的患者。如果经验性抗生素治疗方案与 IDSA/ATS 推荐的 CAP、HAP 和 HCAP 治疗方案一致，则定义为符合指南。通过逻辑回归模型评估结局。
317 例患者诊断为肺炎。只有 38.8%的患者接受了符合指南的经验性抗生素治疗方案。然而，指南的依从性与结局之间没有显著相关性。HAP、年龄较大和更高的 CIRS 严重程度指数是与住院死亡率相关的主要因素。
抗生素治疗指南的依从性较差，特别是对于 HAP 和 HCAP，这表明需要更好地遵循老年人肺炎抗生素最佳管理的指南。
