Antimicrobial therapy for patients with community-acquired pneumonia in the emergency department: results from a French national audit

Abstract

Background: The updated French guidelines for the management of antimicrobial therapy and site-of-care for adults’ community-acquired pneumonia (CAP) were published in July, 2010, stratifying patients in 6 groups depending on age, significant underlying disorders and organ failure. Objectives: We conducted the first national audit of adherence to the latest CAP guidelines. Methods: A web-based audit tool was developed as part of the guidelines. French Emergency Departments (EDs) were invited to participate in the audit capturing data on adults visiting EDs with suspected CAP within the study period(15th October-15th December, 2010). Results: A total of 3.166 cases were provided from 72 EDs. Median age was 75 years (range 15-106 years), 55% were male. CRB65 score was 0 in 22.9 %, 1-2 in 67.8%, and 3-4 in 9.2%; 2630 (83.5%) patients were admitted after ED visit including 335 (12.7%) in intensive care units. Median delay to first antibiotics was 3h45min. Initial empirical antimicrobial treatment was in accordance with French CAP guidelines in 895 (28.3 %) patients. However, adherence widely varied (0%-66.9%) in the patient groups. Of note, 354 (11.2%) did not receive any antibiotics and antimicrobial agents were not in adherence with guidelines in 1917 (60.5%) patients. Conclusions: Management of CAP often differs from guidelines in French emergency departments. This result questions whether emergency physicians are aware of the recommendations or whether recommendations are adequate for emergency CAP patients. Keywords: Audit; Antimicrobial agent; Emergency department; Community-Acquired pneumonia; Site of care