Menéndez, RosarioTorres, AntoniReyes, SoledadZalacain, RafaelCapelastegui, AlbertoRajas, OlgaBorderías, LuisMartín-Villasclaras, Juan J.Bello, SalvadorAlfageme, InmaculadaRodríguez de Castro, FelipeRello, JordiMolinos, LuisRuiz-Manzano, Juan2013-03-182013-03-182012-05-22Menéndez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Rajas O, et al. Compliance with guidelines-recommended processes in pneumonia: impact of health status and initial signs. PLoS ONE. 2012; 7(5):e37570http://hdl.handle.net/10668/849Journal Article; Research Support, Non-U.S. Gov't;Initial care has been associated with improved survival of community-acquired pneumonia (CAP). We aimed to investigate patient comorbidities and health status measured by the Charlson index and clinical signs at diagnosis associated with adherence to recommended processes of care in CAP. We studied 3844 patients hospitalized with CAP. The evaluated recommendations were antibiotic adherence to Spanish guidelines, first antibiotic dose <6 hours and oxygen assessment. Antibiotic adherence was 72.6%, first dose <6 h was 73.4% and oxygen assessment was 90.2%. Antibiotic adherence was negatively associated with a high Charlson score (Odds ratio [OR], 0.91), confusion (OR, 0.66) and tachycardia ≥100 bpm (OR, 0.77). Delayed first dose was significantly lower in those with tachycardia (OR, 0.75). Initial oxygen assessment was negatively associated with fever (OR, 0.61), whereas tachypnea ≥30 (OR, 1.58), tachycardia (OR, 1.39), age >65 (OR, 1.51) and COPD (OR, 1.80) were protective factors. The combination of antibiotic adherence and timing <6 hours was negatively associated with confusion (OR, 0.69) and a high Charlson score (OR, 0.92) adjusting for severity and hospital effect, whereas age was not an independent factor. Deficient health status and confusion, rather than age, are associated with lower compliance with antibiotic therapy recommendations and timing, thus identifying a subpopulation more prone to receiving lower quality care.enAntibacterianosAdhesión a DirectrizEstado de SaludHospitalesNeumoníaGuías de Práctica Clínica como AsuntoEstudios ProspectivosResultado del TratamientoEspañaMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::AgedMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and overMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial AgentsMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Guideline AdherenceMedical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Measurements::Demography::Health StatusMedical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::HospitalsMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Named Groups::Persons::Age Groups::Adult::Middle AgedMedical Subject Headings::Diseases::Respiratory Tract Diseases::Respiratory Tract Infections::PneumoniaMedical Subject Headings::Health Care::Health Care Quality, Access, and Evaluation::Quality Assurance, Health Care::Guidelines as Topic::Practice Guidelines as TopicMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective StudiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective StudiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment OutcomeMedical Subject Headings::Named Groups::Persons::Age Groups::Adultresearch article22629420open access10.1371/journal.pone.00375701932-6203PMC3358284