Adherence to Guidelines Based Empirical Antibiotic Therapy in the Treatment of Community Acquired Pneumonia and its Impact on Patients Outcome

Background: In community acquired pneumonia, rapid selection and initiation of appropriate antibiotic therapy is vital, shortening the illness course and significantly reducing the risk of complications or mortality. Objective: The purpose of this work was to study the compliance and the impact of adherence to 2007 infectious diseases society of America (IDSA) guidelines for treatment of community acquired pneumonia on patients outcome. Methods: The current study was conducted as a prospective observational study involving 100 patients admitted to Critical care Department and diagnosed as having community acquired pneumonia. We recorded demographic data, comobidities, antibiotic treatment data, data on severity of critical illness using Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system pneumonia severity index (PSI). Outcome parameters were also recorded included mortality, length of stay, need for mechanical ventilation (its duration, ventilator free days), time to clinical stability, time to radiological resolution 30 days readmission rate. All data were statistically analyzed. Results: Out of 100 studied patients, 44 were females. The mean age was 61.4 years. Fifty nine patients received IDSA guidelines adherent antibiotic therapy (Group A) while 41 patients received initial therapy discordant with the guidelines (Group B). Patient demographics were similar in both groups. There was no statistical significant difference between the two studied groups in the baseline severity scores as assessed by the APACHE II score (17.6 vs 17.9,p:0.319) pneumonia severity index (p:0.321). The guidelines adherent group showed a statistically significant lower mortality rate (13.6 vs 56.1%,p 0.001), lower mean duration of ICU stay (10.3 days vs 15.5 days, p 0.001) higher ventilator free days (6.3 days vs 3.5 days, p 0.001) when compared to the guidelines non adherent group yet the guidelines adherent therapy was not associated with reductions in time to clinical stability or time to radiological resolution. In a multivariate analysis, age adherence to guidelines based antibiotic therapy were predictors for 30 days readmission. Conclusion: Local compliance to IDSA guidelines is moderate. Adherence to guidelines based empirical antibiotic therapy in patients admitted to the intensive care unit with community acquired pneumonia was associated with reduction in the inpatient mortality, length of ICU stay, and 30 days readmission rate with higher ventilator free days but not associated with any beneficial effect regarding need for ventilatory assistance, time to clinical stability or time to radiological resolution.