Causas de la falta de adherencia a las guías terapéuticas para la neumonía grave

Autor Principal: Gattarello, SimoneRamírez, SergioAlmarales, José RafaelBorgatta, BárbaraLagunes, LeonelEncina, BelénRello, Jordi
Tipo:
Idioma: enes
Publicado em: Rev. bras. ter. intensivaRevista Brasileira de Terapia Intensiva
Assuntos:
Link Texto Completo: http://www.scielo.br/scielo.php?script=sci_arttext&lang=pt&pid=S0103-507X2015000100044
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Objective: To assess the adherence to Infectious Disease Society of America/American Thoracic Society guidelines and the causes of lack of adherence during empirical antibiotic prescription in severe pneumonia in Latin America.

Methods: A clinical questionnaire was submitted to 36 physicians from Latin America; they were asked to indicate the empirical treatment in two fictitious cases of severe respiratory infection: community-acquired pneumonia and nosocomial pneumonia.

Results: In the case of communityacquired pneumonia, 11 prescriptions of 36 (30.6%) were compliant with international guidelines.

The causes for non-compliant treatment were monotherapy (16.0%), the unnecessary prescription of broad-spectrum antibiotics (40.0%) and the use of non-recommended antibiotics (44.0%).

In the case of nosocomial pneumonia, the rate of adherence to the Infectious Disease Society of America/American Thoracic Society guidelines was 2.8% (1 patient of 36).

The reasons for lack of compliance were monotherapy (14.3%) and a lack of dual antibiotic coverage against Pseudomonas aeruginosa (85.7%).

If monotherapy with an antipseudomonal antibiotic was considered adequate, the antibiotic treatment would be adequate in 100% of the total prescriptions.

Conclusion: The compliance rate with the Infectious Disease Society of America/American Thoracic Society guidelines in the community-acquired pneumonia scenario was 30.6%; the most frequent cause of lack of compliance was the indication of monotherapy.

In the case of nosocomial pneumonia, the compliance rate with the guidelines was 2.8%, and the most important cause of non-adherence was lack of combined antipseudomonal therapy.

If the use of monotherapy with an antipseudomonal antibiotic was considered the correct option, the treatment would be adequate in 100% of the prescriptions.