Management of community acquired pneumonia in adults following clinical guidelines at a rural hospital

• Published in: Revista medíca de Chile Vol. 137; no. 10; pp. 1283 - 1290
• Main Authors: Sanhueza A, Luis Manuel, Vásquez P, Cristián, Sepúlveda Z, Fabiola, Barahona C, Francisca, González C, Rubén, Saldías P, Fernando
• Format: Journal Article
• Language: Spanish
• Published: Chile 01-10-2009
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; beta-Lactamases - therapeutic use; Cephalosporins - therapeutic use; Chile; Community-Acquired Infections - drug therapy; Community-Acquired Infections - mortality; Drug Administration Schedule; Female; Guideline Adherence; Hospitals, Rural; Humans; Immunocompetence; Length of Stay - statistics & numerical data; Male; Middle Aged; Pneumonia - drug therapy; Pneumonia - mortality; Treatment Outcome; Young Adult; Chile
• ISSN: 0034-9887
• DOI: 10.4067/S0034-98872009001000002

A National Consensus Guideline published in 2005 established the basis for the diagnostic, severity assessment and treatment of community acquired pneumonia (CAP) in the adult population. The compliance with pneumonia clinical guidelines has been associated to a reduction in hospital stay healthcare-related costs, morbidity and mortality.
To describe the management and outcome of non-severe CAP in hospitalized adult patients treated in a rural hospital, based on the national clinical guidelines.
Ninety six patients aged 74 +/- 13 years (50 males) hospitalized with non-severe pneumonia (group 3) at a community-based primary care center between January 1, 2006, and March 31, 2007, were evaluated.
Eighty percent of patients had concomitant diseases such as hypertension in 49%, diabetes in 23% and chronic obstructive pulmonary disease in 18%. All were treated with a third generation cephalosporin (ceftriaxone 1-2 g/day TV) as empirical therapy. Only 9% of patients also received a macrolide. Early switch to oral antimicrobial therapy was successful in two third of cases. Mean hospital length of stay was 5.0 +/- 2.5 days, and 30-day mortality was 6.3%.
Following the recommendations of the national clinical guidelines, most of these patients had a favorable response to monotherapy with a beta-lactam antimicrobial. Early switch therapy to oral antibiotic was effective and safe, reducing significantly hospital length of stay as compared to previous national clinical studies.