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Hospital-acquired pneumonia: coverage and treatment adequacy of current guidelines

¹ National Institute of Pulmonology "Marius Nasta", Bucharest, Romania. ² Clinic Institute of Pulmonology and Thoracic Surgery, and ³ Dept of Microbiology, Hospital Clinic, Barcelona, Spain.

CORRESPONDENCE: A. Torres, Institut Clinic de Pneumologia i Cirurgia Toracica, Hospital Clinic, Villarroel 170, 08036, Barcelona, Spain. Fax: 34 932279813. E-mail: atorres@medicina.ub.es

Keywords: guidelines, hospital-acquired pneumonia, treatment adequacy

Received: April 24, 2003
Accepted June 24, 2003

M. Ioanas was a recipient of a European Respiratory Society Research Fellowship in 2000, M. Cavalcanti in 2003 and M. Valencia in 2002. The study was supported by Red Gira and Red Respira.

The American Thoracic Society (ATS) guideline for hospital-acquired pneumonia (HAP) released in 1996 and the Trouillet classification published in 1998 supply different rational foundations for the classification of patients with HAP and for the selection of initial antibiotic therapy. The aims of this study were to assess the level of bacterial coverage and to assess and validate the adequacy of antibiotic strategy of each of these classifications.

Intensive care unit-admitted patients (n=71) with suspicion of HAP were evaluated. The ATS and Trouillet classifications demonstrated an accuracy to predict the causative microorganism of 91% and 83%, respectively. The ATS and Trouillet antibiotic treatment recommendations were adequate in 79% and 80% of the patients, respectively. The microorganisms implicated in the treatment inadequacy of the ATS guideline were Pseudomonas aeruginosa (n=3), Acinetobacter baumanii (n=1), Stenotrophomonas maltophilia (n=1) and methicillin-resistant Staphylococcus aureus (n=1). P. aeruginosa was implicated with Trouillet treatment inadequacy.

The current recommendations for empirical antibiotic treatment of hospital-acquired pneumonia (American Thoracic Society and Trouillet) showed a good ability to predict the involved pathogen. However, considering the resistance pattern of the isolated pathogens, both classifications demonstrated a rather lower treatment adequacy; the main reason was the failure to treat highly resistant strains.

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