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ORIGINAL INVESTIGATION Guideline-Concordant Therapy and Reduced Mortality and Length of Stay in Adults With Community-Acquired Pneumonia Playing by the Rules Caitlin McCabe, BSc; Cheryl Kirchner, RN, BSN, MS; Huiling Zhang, MD, MPH, MBA; Jennifer Daley, MD, MPH; David N. Fisman, MD, MPH, FRCPC Background: Community-acquired pneumonia (CAP) ness and other confounders, guideline-concordant therapy is a major cause of morbidity and mortality worldwide. was associated with decreased in-hospital mortality (odds Clinical practice guidelines for empirical CAP treat- ratio [OR], 0.70; 95% confidence interval [CI], 0.63- ment, formulated jointly by the Infectious Diseases So- 0.77), sepsis (OR, 0.83; 95% CI, 0.72-0.96), and renal fail- ciety of America (IDSA) and American Thoracic Society ure (OR, 0.79; 95% CI, 0.67-0.94), and reduced both length (ATS), remain controversial and inconsistently applied. of stay and duration of parenteral therapy by approxi- We evaluated the impact of guideline-concordant therapy mately 0.6 days (P.001 for both comparisons). These on in-hospital survival and other outcomes using a large findings were robust with alternate definitions of “con- database including adults treated for CAP in both com- cordance” and were linked to treatment with fluoroqui- munity and tertiary care hospitals. nolone or macrolide agents. Methods: We evaluated the association between
JAMA Internal Medicine – American Medical Association
Published: Sep 14, 2009
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