PMID- 19752410
OWN - NLM
STAT- MEDLINE
DCOM- 20091002
LR  - 20230411
IS  - 1538-3679 (Electronic)
IS  - 0003-9926 (Linking)
VI  - 169
IP  - 16
DP  - 2009 Sep 14
TI  - Improving outcomes in elderly patients with community-acquired pneumonia by 
      adhering to national guidelines: Community-Acquired Pneumonia Organization 
      International cohort study results.
PG  - 1515-24
LID - 10.1001/archinternmed.2009.265 [doi]
AB  - BACKGROUND: To define whether elderly patients hospitalized with 
      community-acquired pneumonia (CAP) had better outcomes if they were treated with 
      empirical antimicrobial therapy adherent to the 2007 Infectious Diseases Society 
      of America (IDSA)/American Thoracic Society (ATS) guidelines for CAP. METHODS: 
      This was a secondary analysis of the CAPO International Cohort Study database, 
      which contained data from a total of 1725 patients aged 65 years or older who 
      were hospitalized with CAP. Data from June 1, 2001, until January 1, 2007, were 
      analyzed from 43 centers in 12 countries including North America (n = 2), South 
      America (n = 4), Europe (n = 4), Africa (n = 1), and Southeast Asia (n = 1). 
      Initial empirical therapy for CAP was evaluated for guideline compliance 
      according to the 2007 IDSA/ATS guidelines for CAP. Time to clinical stability, 
      length of stay (LOS), total in-hospital mortality, and CAP-related mortality for 
      each group were calculated. Comparisons between groups were made using cumulative 
      incidence curves and competing risks regression. RESULTS: Among the 1649 patients 
      with CAP, aged 65 years or older, 975 patients were given antimicrobial regimens 
      adherent to the IDSA/ATS for CAP guidelines, while 660 patients were treated with 
      nonadherent regimens (465 patients were "undertreated"; 195 were "overtreated"). 
      Adherence to guidelines was associated with a statistically significant decreased 
      time to achieve clinical stability compared with nonadherence: the proportion of 
      patients who reached clinical stability by 7 days was 71% (95% confidence 
      interval [CI], 68%-74%) and 57% (95% CI, 53%-61%) (P < .01), respectively. 
      Guideline adherence was also associated with shorter LOS (median adherence LOS, 8 
      days; interquartile range [IQR], 5-15 days; median nonadherence LOS, 10 days; 
      IQR, 6-24 days) (P < .01) and decreased overall in-hospital mortality (8%; 95% 
      CI, 7%-10% vs 17%; 95% CI, 14%-20%) (P < .01). CONCLUSION: Implementation of 
      national guidelines at the local hospital level will improve not only mortality 
      and LOS of elderly patients hospitalized with CAP but also time to clinical 
      stability.
FAU - Arnold, Forest W
AU  - Arnold FW
AD  - Division of Infectious Diseases, Department of Medicine, School of Medicine, 
      University of Louisville, 627 Preston St, Ste 100, Louisville, KY 40202, USA. 
      f.arnold@louisville.edu
FAU - LaJoie, A Scott
AU  - LaJoie AS
FAU - Brock, Guy N
AU  - Brock GN
FAU - Peyrani, Paula
AU  - Peyrani P
FAU - Rello, Jordi
AU  - Rello J
FAU - Menendez, Rosario
AU  - Menendez R
FAU - Lopardo, Gustavo
AU  - Lopardo G
FAU - Torres, Antoni
AU  - Torres A
FAU - Rossi, Paolo
AU  - Rossi P
FAU - Ramirez, Julio A
AU  - Ramirez JA
CN  - Community-Acquired Pneumonia Organization (CAPO) Investigators
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anti-Infective Agents)
RN  - 0 (beta-Lactams)
SB  - IM
CIN - Arch Intern Med. 2009 Sep 14;169(16):1462-4. PMID: 19752402
MH  - Aged
MH  - Aged, 80 and over
MH  - Anti-Infective Agents/*therapeutic use
MH  - Cohort Studies
MH  - Community-Acquired Infections/drug therapy
MH  - Drug Therapy, Combination
MH  - Female
MH  - *Guideline Adherence
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Pneumonia/*drug therapy/mortality
MH  - Retrospective Studies
MH  - beta-Lactams/*therapeutic use
EDAT- 2009/09/16 06:00
MHDA- 2009/10/03 06:00
CRDT- 2009/09/16 06:00
PHST- 2009/09/16 06:00 [entrez]
PHST- 2009/09/16 06:00 [pubmed]
PHST- 2009/10/03 06:00 [medline]
AID - 169/16/1515 [pii]
AID - 10.1001/archinternmed.2009.265 [doi]
PST - ppublish
SO  - Arch Intern Med. 2009 Sep 14;169(16):1515-24. doi: 
      10.1001/archinternmed.2009.265.