Compliance with guidelines-recommended processes in pneumonia: Impact of health status and initial signs

Abstract

Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigatepatient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated withadherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluatedrecommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose,6 hours and oxygen assessment.Antibiotic adherence was 72.6%, first dose,6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence wasnegatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia$100 bpm(OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment wasnegatively associated with fever (OR, 0.61), whereas tachypnea$30 (OR, 1.58), tachycardia (OR, 1.39), age.65 (OR, 1.51)and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing,6 hours was negativelyassociated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereasage was not an independent factor. Deficient health status and confusion, rather than age, are associated with lowercompliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receivinglower quality care.