Multicenter Intervention Program to Optimize the Clinical Management of Community-acquired Pneumonia in Hospitals

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the impact of a structured package (bundle) in reducing the use of antimicrobials and hospital stay of patients with community-acquired pneumonia (CAP), and no increase in mortality of these patients in different hospitals.

Official Title
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Multicenter Intervention Program to Optimize the Clinical Management of Community-acquired Pneumonia in Hospitals

Conditions
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Community Acquired Pneumonia

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of CAP at hospital admission . Age: 18 years or more. Exclusion Criteria: Patients with nosocomial pneumonia or criteria related to health care. Patients with severe immunosuppression (HIV infection with <200 CD4+ lymphocytes / mm3), neutropenia (<500 neutrophils / mm3). Patient treated with immunosuppressive drugs.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-intervention All patients admitted with a diagnosis of CAP<br> | |
| Post intervention All patient admitted with a diagnosis of CAP<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antimicrobial use in patients hospitalized for CAP. | It is measured in defined daily doses (DDD) per 100 hospital stay of patients hospitalized with CAP. | twelve months | 
| Mortality rate to 30 days | Number of death of patients hospitalized with CAP, stratified by CURB-65 score. | twelve months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CAP severity CURB-65 or PSI registered. | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Numbers of doctors who register on the clinical history the evaluation of CAP severity by CURB-65 or PSI at hospitalization. | twelve months | 
| Microbiological samples at admission. | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Numbers of doctors who taking all microbiological samples recommended in the guideline in the first 6 hours of patient admission. | twelve months | 
| Appropriate supportive treatment | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Number of doctors who take supportive treatment according to guideline during the hospitalization. | Twelve months | 
| Empirical treatment | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Number of doctors who prescribed empirical treatment according to the guideline at admission. | Twelve months | 
| Appropriate sequential therapy. | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Number of doctors who switch to oral therapy according to guideline. | Twelve months | 
| Specific antimicrobial treatment | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Number of doctors who prescribed the specific antimicrobial treatment defined in the guideline | Twelve months | 
| Total duration of antibiotic therapy. | Implementation of quality indicators in the management of CAP. They are expressed as dichotomous variables (yes / no): Number of doctors who prescribe an antimicrobial treatment during 7 days or less, or 5 days or less after clinical improvement. | Twelve months |