Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotictreatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American ThoracicSociety (ATS) in hospitalized elderly people (65 years or older).Methods: Data were obtained fromREPOSI, a prospective registry held in 87 Italian internal medicine and geriatricwards. Patientswith a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumoniaas indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines ifconcordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes wereassessed by logistic regression models.Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibioticregimen that was adherent to guidelines. However, no significant association was found between adherence toguidelines and outcomes. Having HAP, older age, and higher CIRS severity indexwere the main factors associatedwith in-hospital mortality.Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggestingthe need for more adherence to the optimal management of antibiotics in the elderly with pneumonia.