ABSTRACT
National organizations from multiple countries have developed evidence-based recommendations
for the management of hospitalized patients with community-acquired pneumonia (CAP).
Good quality of care in CAP can be defined as patient care provided in compliance
with evidence-based recommendations. To evaluate the quality of care provided to hospitalized
patients with CAP, an international network of investigators is collecting local data
on quality indicators from 36 hospitals in 14 countries. Participating countries in
four regions are performing worldwide benchmarking: North America (region I), Europe
(region II), Latin America (region III), and Asia and Africa (region IV). The quality
of care provided to 2750 hospitalized patients with CAP was evaluated in the following
areas: diagnosis, hospitalization, respiratory isolation, microbiological workup,
empirical therapy, switch therapy, hospital discharge, and prevention. The greatest
opportunities for improvement were identified in the areas of prevention of CAP, initial
empirical therapy, and switch from intravenous to oral antibiotics. This study indicates
that the care recommended by national guidelines is not being appropriately delivered
to adults in all regions of the world. New interventions to advance quality of care
are necessary to improve clinical and economic outcomes in CAP.
KEYWORDS
Community-acquired pneumonia - quality indicators - quality of care - national evidence-based
guidelines - international
REFERENCES
1
Niederman M, Mandell L, Anzueto A et al..
Guidelines for the management of adults with community-acquired pneumonia. American
Thoracic Society.
Am J Respir Crit Care Med.
2001;
163
1730-1754
2
Mandell L, Bartlett J, Dowell S, File T, Musher M, Fine M J.
Update of practice guidelines for the management of community-acquired pneumonia in
immunocompetent adults: guidelines from the Infectious Diseases Society of America.
Clin Infect Dis.
2003;
37
1405-1433
3
Mandell L A, Marrie T J, Grossman R F, Chow A W, Hyland R H.
Canadian guidelines for the initial management of community-acquired pneumonia: an
evidence-based update by the Canadian Infectious Diseases Society and the Canadian
Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group.
Clin Infect Dis.
2000;
31
383-421
4
Luna C M, Jardím J R, López H et al..
Actualizacion de las recomendaciones ALAT sobre la neumonia adquirida en la comunidad.
Arch Bronconeumol.
2004;
40
364-374
5
Macfarlane J. and the Pneumonia Guidelines Committee of the British Thoracic Society
Group .
BTS Guidelines for the Management of Community Acquired Pneumonia in Adults.
Thorax.
2001;
56(Suppl IV)
iv1-iv64
, (Update 2004 www.brit-thoracic.org.uk)
6
Alfageme I, Aspa J, Bello S et al..
Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia. Spanish
Society of Pulmonology and Thoracic Surgery (SEPAR).
Arch Bronconeumol.
2005;
41
272-289
7
Khanzada Z, Rodriquez E, Cosentini R and the CAPO investigators et al.
Discrepancies between physicians' clinical diagnosis of community-acquired pneumonia
and diagnosis based on objective criteria: results from the community-acquired pneumonia
organization (CAPO) international cohort study [abstract 356504]. Abstracts from 2004
International ATS Conference.
Am J Respir Crit Care Med.
2004;
169
A654
8
Arnold F, Ramirez J, McDonald C, Xia E.
Hospitalization for community-acquired pneumonia: the pneumonia severity index vs
clinical judgment.
Chest.
2003;
124
121-124
9
Christensen D, Feldman C, Rossi P and the CAPO investigators et al.
HIV infection does not influence clinical outcomes in hospitalized patients with bacterial
community-acquired pneumonia: results from the CAPO international cohort study.
Clin Infect Dis.
2005;
41
554-556
10 Core Curriculum on Tuberculosis .What the Clinician Should Know. 4th ed. Atlanta;
U.S. Department of Health & Human Services, Centers for Disease Control and Prevention,
National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination
2000
11
Christensen D, Xia E, Anjum R and the CAPO investigators et al.
How common are risk factors for tuberculosis in hospitalized patients with pneumonia?
Results from the community-acquired pneumonia organization (CAPO) international cohort
study [abstract 1428]. Abstracts from 2003 International ATS Conference.
Am J Respir Crit Care Med.
2003;
167
A817
12
Christensen D, McDonald C, Xia E and the CAPO investigators et al.
Defining risk factors for tuberculosis in hospitalized patients with pneumonia: results
from the community-acquired pneumonia organization (CAPO) international cohort study
[abstract 1481]. Abstracts from 2003 International ATS Conference.
Am J Respir Crit Care Med.
2003;
167
A609
13
Christensen D, De la Cruz R, Levy G et al..
Bacteremic community-acquired pneumonia: the importance of Staphylococcus aureus: results from the community-acquired pneumonia organization (CAPO) international cohort
study [abstract 3062]. Abstracts from 2005 International American Thoracic Society
Conference, San Diego, California.
Am J Respir Crit Care Med.
2005;
171
A173
14
Arnold F W, Summersgill J T, Blasi F et al..
Community-acquired pneumonia due to atypical pathogens: a worldwide comparison of
the incidence and initial empiric therapy: results from the community-acquired pneumonia
organization (CAPO) international cohort study [abstract 3850]. Abstracts from 2005
International American Thoracic Society Conference, San Diego. California.
Am J Respir Crit Care Med.
2005;
171
A46
15
Arnold F, Blasi F, Roig J and the CAPO investigators et al.
Empiric antibiotic therapy with coverage for atypical pathogens is associated with
better outcomes in hospitalized patients with community-acquired pneumonia: results
from the community-acquired pneumonia organization (CAPO) international cohort study
[abstract 356346]. Abstracts from 2004 International ATS Conference.
Am J Respir Crit Care Med.
2004;
169
A126
16
De la Cruz R, Marrie T, Fernandez P and the CAPO investigators et al.
Association of initial empiric antibiotic therapy with length of stay and mortality
in hospitalized patients with community-acquired pneumonia: results from the community-acquired
pneumonia organization (CAPO) international cohort study [abstract 356563]. Abstracts
from 2004 International ATS Conference.
Am J Respir Crit Care Med.
2004;
169
A127
17
Houck P M, Bratzler D W, Nsa W, Ma A, Bartlett J G.
Timing of antibiotic administration and outcomes for Medicare patients hospitalized
with community-acquired pneumonia.
Arch Intern Med.
2004;
164
637-644
18
Ramirez J A, Bordon J.
Early Switch from Intravenous to Oral Antibiotics in Hospitalized Patients with Bacteremic
Streptococcus pneumoniae Community-Acquired Pneumonia.
Arch Intern Med.
2001;
161
848-850
19
De la Cruz R, Christensen D, Martinez J et al..
Hospitalized patients with community-acquired pneumonia do not benefit from continuing
intravenous antibiotics after reaching clinical stability: results from the community-acquired
pneumonia organization (CAPO) international cohort study [abstract 3880]. Abstracts
from 2005 International American Thoracic Society Conference. San Diego, California.
Am J Respir Crit Care Med.
2005;
171
A47
20
Peyrani P, Weiss K, Legnani D et al..
Hospitalized patients with community-acquired pneumonia do not benefit from in-hospital
observation after switch therapy is performed: results from the community-acquired
pneumonia organization (CAPO) international cohort study [abstract C86]. Abstracts
from 2005 International American Thoracic Society Conference. San Diego, California.
Am J Respir Crit Care Med.
2005;
171
A798
21
Christensen D, Gross P, Legnani D and the CAPO investigators et al.
Strategies to prevent pneumonia are used infrequently in hospitalized patients with
community-acquired pneumonia: results from the community-acquired pneumonia organization
(CAPO) international cohort study [abstract 4106]. Abstracts from 2004 International
ATS Conference.
Am J Respir Crit Care Med.
2004;
169
A728
22 Ramirez J A.
Process for implementing a local practice guideline . In: Pollard H Community-Acquired Pneumonia: A Plan for Implementing National Guidelines
at the Local Hospital Level. Philadelphia; Lippincott Williams & Wilkins 2003
Julio A RamírezM.D.
Division of Infectious Diseases, University of Louisville, 512 South Hancock St.,
Carmichael Bldg., Rm. 208-D, Louisville, KY 40202
Email: j.ramirez@louisville.edu