Among intensive care unit patients with pneumonia and risk factors for a multidrug-resistant pathogen, guideline-compliant treatment was associated with increased mortality.
Today's focus on evidence-based medicine has increased the emphasis on developing and following clinical practice guidelines — sometimes even when supporting data are limited. In 2005, the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) jointly released guidelines for the management of hospital-acquired pneumonia (HAP). Now, in a prospective, industry-supported, multicenter trial, investigators have examined whether compliance with these guidelines improves outcomes among intensive care unit patients with pneumonia potentially caused by multidrug-resistant organisms.
During the 18-month study, 413 adult patients were assessed, and 303 met inclusion criteria. Of these patients, 129 received guideline-compliant empirical treatment (2 agents effective against gram-negative pathogens and coverage for methicillin-resistant Staphylococcus aureus), and 174 received a regimen that was noncompliant (most often because of single — rather than dual — gram-negative coverage).
The 28-day mortality rate was higher for the patients who received a guideline-compliant empirical regimen than for those who received a noncompliant regimen (34% vs. 20%; hazard ratio, 1.89; 95% confidence interval, 1.21–2.95). Patients who received guideline-compliant treatment were more likely to have severe sepsis, had a slightly higher mean APACHE II score, and were more likely to have Pseudomonas aeruginosa isolated as a pathogen, but the increased mortality risk appeared to be independent of these factors.
Kett DH et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: An observational, multicentre cohort study. Lancet Infect Dis 2011 Jan 20; [e-pub ahead of print]. (http://viajwat.ch/ehkpLC)
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