Proceso de atención y prescripción en neumonía adquirida en la comunidad en hospitales universitarios en Colombia
Proceso de atención y prescripción en neumonía adquirida en la comunidad en hospitales universitarios en Colombia
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Objective: To describe the process of care and prescription practices for CAP patients in tour university hospitals in Colombia.
Design: Cohort study.
Setting: Four third-level University Hospitals in three Colombian citíes.
Patients and Methods: Patients older than 15 years with a diagnosis of CAP during the two years study period. Collection of demographic and clínical status data and management during the first day of consult. Classification in severity groups according to Fine 's prediction rule. Evaluation of the frequency of use of ancíllary diagnostic tests, antimicrobials prescription and agreement with ATS guidelines, according to severity group and hospital.
Results: 734 patients were included, mean age 56 years old, 50.5% males, mean length of stay 8.6 days, 39% Fine 's classes IV to V. Frequency of sputum sampling [overall cohort (between hospitals rank)] was 46% (10 - 67%), chest X-ray 95% (57-100%), blood cultures 34% (O - 63%) and arterial blood gas analysis 71% (10 - 88%). The use of ancíllary diagnostic test had wide variation between hospitals and severity classes, specially for sputum and blood gases. At least 45 different antimicrobial protocols were used in the cohort. Overall agreement between actual prescription and guidelines recommendations was variable (mean 44%, range 22 to 72%) between groups and hospitals, but without significant impact on mortality.
Conclusions: There are many differences between actual clinical practice and guidelines for the management of CAP and wide variations between hospitals, but the precise effect of the lack of guideline-adherence on mortality is unclear.
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