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Adherence to antibiotic guidelines for pneumonia in chronic-care facilities in Ontario
1Division of Medical Microbiology and Infectious Diseases, McMaster University and the Hamilton Regional Laboratory Program, Ont. loebm@mcmaster.ca
Objectives:
To evaluate adherence to antibiotic recommendations for the treatment of pneumonia in patients who receive long-term care and to assess outcomes associated with these recommendations.
Design:
A prospective cohort study.
Setting:
Twenty-two facilities that provide long-term care in southern Ontario.
Participants:
Older adults treated with antibiotics for a presumptive diagnosis of pneumonia and those with radiologically confirmed pneumonia
Methods:
Over a 12-month period, older patients who were treated with antibiotics for presumptive pneumonia were prospectively identified. A random sample of these antibiotic courses (646 courses in 638 patients) was reviewed using a standardized data collection form, and demographic and clinical data were collected. Antibiotic courses were classified according to Canadian and American Thoracic Society antibiotic recommendations for pneumonia. In patients with radiologically confirmed pneumonia, the effect of adherence to these recommendations on mortality and persistence of symptoms was assessed.
Results:
Only 27.6% (178 of 646) of antibiotic prescriptions evaluated met antibiotic recommendations for nursing-home-acquired pneumonia, and the proportion meeting these varied greatly by facility, ranging from 0% to 53% (median 31%). For patients with radiologically confirmed pneumonia, age (adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.0-2.4, per increase in 10 yr, p = 0.02), sex (adjusted OR 3.0, 95% CI 1.1-8.0, p = 0.03), and adherence to recommended antibiotics (OR 3.0, 95% CI 1.3-7.2, p = 0.01) were associated with death. Adherence to the recommended antibiotics was also associated with adverse reactions, which occurred in 10% of prescriptions meeting the recommendations (OR 2.4, 95% CI 1.3-4.6, p = 0.01).
Conclusions:
Adherence to recommended guidelines for antibiotic treatment was low and highly variable among study facilities. Use of recommended antibiotic regimens was associated with increased adverse events and worse outcomes in patients with radiologically confirmed pneumonia.