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Eur J Intern Med. 2015 Jun;26(5):330-7. doi: 10.1016/j.ejim.2015.04.002. Epub 2015 Apr 18.

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia.

Collaborators (320)

Mannucci M, Nobili A, Tettamanti M, Pasina L, Franchi C, Salerno F, Corrao S, Marengoni A, Marcucci M, Sparacio E, Alborghetti S, Di Costanzo R, Eldin TK, Tettamanti M, Djade CD, Prisco D, Silvestri E, Cenci C, Barnini T, Delitala G, Carta S, Atzori S, Guarnieri G, Zanetti M, Spalluti A, Serra MG, Bleve MA, Vanoli M, Grignani G, Casella G, Gasbarrone L, Maniscalco G, Gunelli M, Tirotta D, Brucato A, Ghidoni S, Di Corato P, Bernardi M, Li Bassi S, Santi L, Agnelli G, Iorio A, Marcucci M, Marchesini E, Mannarino E, Lupattelli G, Rondelli P, Paciullo F, Fabris F, Carlon M, Turatto F, Baroni MC, Zardo M, Manfredini R, Molino C, Pala M, Fabbian F, Nuti R, Valenti R, Ruvio M, Cappelli S, Paolisso G, Rizzo MR, Laieta MT, Salvatore T, Sasso FC, Utili R, Durante Mangoni E, Pinto D, Olivieri O, Stanzial AM, Fellin R, Volpato S, Fotini S, Barbagallo M, Dominguez L, Plances L, D'Angelo D, Rini G, Mansueto P, Pepe I, Licata G, Calvo L, Valenti M, Borghi C, Strocchi E, Rinaldi ER, Zoli M, Fabbri E, Magalotti D, Auteri A, Pasqui AL, Puccetti L, Laghi Pasini F, Capecchi PL, Bicchi M, Sabbà C, Vella FS, Marseglia A, Luglio CV, Palasciano G, Modeo ME, Aquilino A, Pugliese S, Capobianco C, Postiglione A, Barbella MR, De Stefano F, Fenoglio L, Brignone C, Bracco C, Giraudo A, Musca G, Cuccurullo O, Cricco L, Fiorentini A, Cappellini MD, Fabio G, Seghezzi S, De Amicis MM, Fargion S, Bonara P, Bulgheroni M, Lombardi R, Magrini F, Massari F, Tonella T, Peyvandi F, Tedeschi A, Rossio R, Moreo G, Ferrari B, Roncari L, Monzani V, Savojardo V, Folli C, Magnini M, Mari D, Rossi PD, Damanti S, Prolo S, Lilleri MS, Cricco L, Fiorentini A, Micale G, Podda M, Selmi C, Meda F, Salerno F, Accordino S, Conca A, Monti V, Corazza GR, Miceli E, Lenti MV, Padula D, Balduini CL, Bertolino G, Provini S, Quaglia F, Murialdo G, Bovio M, Dallegri F, Ottonello L, Quercioli A, Barreca A, Secchi MB, Ghelfi D, Chin WS, Carassale L, Caporotundo S, Anastasio L, Sofia L, Carbone M, Di Carlo S, Traisci G, De Feudis L, Davì G, Guagnano MT, Sestili S, Bergami E, Rizzioli E, Cagnoni C, Bertone L, Manucra A, Buratti A, Tognin T, Liberato NL, Bernasconi G, Nardo B, Bianchi GB, Giaquinto S, Benetti G, Quagliolo M, Centenaro GR, Purrello F, Di Pino A, Piro S, Mancuso G, Calipari D, Bartone M, Gullo F, Cortellaro M, Magenta M, Perego F, Meroni MR, Cicardi M, Gidaro A, Magenta M, Sacco A, Bonelli A, Dentamaro G, Rozzini R, Falanga L, Giordano A, Perin PC, Lorenzati B, Gruden G, Bruno G, Montrucchio G, Greco E, Tizzani P, Fera G, Di Luca ML, Renna D, Perciccante A, Coralli A, Tassara R, Melis D, Rebella L, Menardo G, Bottone S, Sferrazzo E, Ferri C, Striuli R, Scipioni R, Salmi R, Gaudenzi P, Gamberini S, Ricci F, Morabito C, Fava R, Semplicini A, Gottardo L, Delitala G, Carta S, Atzori S, Vendemiale G, Serviddio G, Forlano R, Bolondi L, Rasciti L, Serio I, Masala C, Mammarella A, Raparelli V, Rossi Fanelli F, Delfino M, Amoroso A, Violi F, Basili S, Perri L, Serra P, Fontana V, Falcone M, Landolfi R, Grieco A, Gallo A, Zuccalà G, Franceschi F, De Marco G, Chiara C, Marta S, Bellusci M, Setti D, Pedrazzoli F, Romanelli G, Pirali C, Amolini C, Rosei EA, Rizzoni D, Castoldi L, Picardi A, Gentilucci UV, Mazzarelli C, Gallo P, Guasti L, Castiglioni L, Maresca A, Squizzato A, Contini S, Molaro M, Annoni G, Corsi M, Zazzetta S, Bertolotti M, Mussi C, Scotto R, Ferri MA, Veltri F, Arturi F, Succurro E, Sesti G, Gualtieri U, Perticone F, Sciacqua A, Quero M, Bagnato C, Loria P, Becchi MA, Martucci G, Fantuzzi A, Maurantonio M, Corinaldesi R, De Giorgio R, Serra M, Grasso V, Ruggeri E, Carozza LM, Pignatti F.

Author information

1
Department of Pathophysiology and Transplantation, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy.
2
Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy. Electronic address: carlotta.franchi@marionegri.it.
3
Dipartimento di Scienze Cliniche e di Comunità, University of Milan, Italy.
4
Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
5
Department of Medical and Surgery Sciences, IRCCS Policlinico San Donato, University of Milan, Italy.
6
Department of Clinical and Experimental Science, University of Brescia, Italy.
7
Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Italy.
8
Geriatrics Unit, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico & Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
9
Scientific Direction, IRCCS Ca' Granda Maggiore Hospital Policlinico Foundation, Milan, Italy.

Abstract

BACKGROUND:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

Antibiotics; Elderly; Guidelines adherence; Mortality; Pneumonia; Re-hospitalization

PMID:
25898778
DOI:
10.1016/j.ejim.2015.04.002
[Indexed for MEDLINE]

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