The use of guidelines for the empiric treatment of hospital-acquired pneumonia
MS Miletin, CK Chan
Several practice guidelines for the empirical antimicrobial
treatment of hospital-acquired pneumonia (HAP) have
been developed, but the acceptance and use of such guidelines
To assess physicians' use of empirical HAP guidelines
published by the American Thoracic Society (ATS) and
by The University Health Network, Toronto, Ontario.
A retrospective assembly and chart review.
A university teaching hospital.
PATIENTS: One hundred
fifteen consecutive patients who had been diagnosed
with pneumonia more than 48 h after admission to hospital
over a 10-month period.
The charts of 115 patients were reviewed. Seventy-five
patients (65%) were treated empirically. Forty patients
(35%) were treated based on microbiological data that
were available before the initiation of antibiotics.
Patients who received nonempirical treatment for HAP
had a significantly greater acuity of illness than the
empirically treated group. Thirty-seven patients (49%)
who received empirical therapy were treated according
to either ATS or hospital guidelines for HAP. The use
of guideline-concordant antimicrobial therapy had no
measurable effect on in-hospital mortality (eight of
37 patients [21.6%] versus seven of 38 patients [18.4%],
P=0.96) or median length of stay (19 days versus 21
days, P=0.30). Patients whose treatment did not follow
guideline recommendations tended to receive appropriate
antimicrobial coverage more often than did those patients
whose treatment was guideline concordant (15 of 18 patients
[83%] versus six of 11 patients [55%], P=0.49).
Institutional and ATS guidelines for the empirical treatment
of HAP are less widely used than would be predicted
by chance at The University Health Network. The clinical
utility of these guidelines remains to be proven.