Community-acquired pneumonia: doctors do not follow guidelines
Abstract number: 1733_682
Beadsworth M.B.J., Collini P., Deegan P., Neal T., Burnham P., Anson J., Beeching N.J., Miller A.R.O.
Objectives: Appropriate assessment of CAP allows accurate severity scoring and hence optimal management, leading to reduced morbidity and mortality. British Thoracic Society (BTS) guidelines provide an appropriate score. We assessed adherence to BTS guidelines in our medical assessment unit (MAU) in 2001/2. We re-assessed adherence in 2005/6, 3 years after introducing an educational programme.
Methods: A retrospective casenote study comparing diagnosis, management and outcome of CAP during admission to MAU during 3 months of winter in 2001/2 and 2005/6. (BTS, CURB-65, scoring was used for 2005/6)
Results: Over 3 months in 2001/2, of 165 patients coded as CAP, 65 were wrongly coded and 100 included in the study. In 2005/6 this had not significantly changed. 130 were coded as CAP, of these 43 were wrongly coded and 87 enrolled. In 2001/2, 48% did not receive a severity score, in 2005/6 this had significantly increased to 87%. (p < 0.0001)
Parenteral antibiotics were used in 79% in 2001/2 and 77% in 2005/6. 3rd generation cephlosporins were used in 63% in 2001/2 and 54% in 2005/6.
In 2001, 15 different antibiotic regimes were prescribed, in 2005/6 this had increased to 19.
Conclusions: Coding remains poor. Adherence to CAP management guidelines was poor and has significantly worsened. Educational programmes, alone, do not improve adherence. Restriction of antibiotic prescribing should be considered.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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