International Guideline concordance of empiric antibiotic use in community-acquired pneumonia

Community-acquired pneumonia (CAP) is the leading infectious cause of death worldwide and its empiric treatment is a critical decision. Several guidelines recommend the appropriate use of antibiotics for patients with CAP, but evidence regarding guideline concordance (GC) is limited to local or regional studies. Our aim was to evaluate the national and international GC of empiric antibiotic selection for hospitalized patients with CAP. Methods: We used the platform of an international, multicenter, point-prevalence study of hospitalized immunocompetent patients with CAP. We analyzed the continental GC according to the recommendations by ERS-2011, ATS/IDSA-2007, and ALAT-2004, and by national guidelines from Portugal, United Kingdom, Pakistan, Spain, India, Germany and Croatia. We stratified the patients according to the site of care in ward or intensive care unit (ICU) admission. Results: We enrolled 3,019 patients with 83% admitted from the ward and 17% from the ICU. At a global level GC was 42%, highest in European countries according to the ERS-2011 (53%), followed by North America (35%) according to ATS/IDSA 2007 guidelines and 33% of South American countries according to ALAT-2004, respectively (p value Conclusions: Adherence to CAP guidelines is suboptimal among the majority of participating countries or at the continental level. Antimicrobial stewardship programs should focus on improving adherence of empiric antibiotic selection in clinical practice.