High incidence rates of C. difficile-associated diarrhea in Canadian hospitals have been reported recently.18-21 Three of the patients in the current study who had received a course of £-lactam antimicrobial therapy experienced C. difficile-associated diarrhea, but no statistical analysis was performed.
The major limitations of this study were the small sample size and the retrospective design. Inclusion of patients with a type 1 diagnosis (i.e., comorbid condition, rather than community-acquired pneumonia, as the most responsible diagnosis influencing the length of stay) would have ensured a larger sample size, but for reasons of feasibility as a residency project and the desire to obtain a sample of patients admitted specifically for community-acquired pneumonia, only patients for whom this diagnosis was the most responsible diagnosis influencing the length of stay were reviewed (i.e., type M diagnosis). The treatment guideline for community-acquired pneumonia used at Sunnybrook is a general guideline for medical staff and residents. Although the guideline is directed toward patients admitted to the ward, and not nursing home residents, patients with specific comorbidities, or patients in the intensive care unit, the objective of this study was still achievable with our methodology. Viagra Professional
There was no significant difference in frequency between levofloxacin monotherapy and second- or third-generation cephalosporin plus macrolide combination therapy at this institution, and 56% of the patients in the study received one of these guideline-based options. To improve compliance with the guidelines for treatment of community-acquired pneumonia in use at Sunnybrook Health Sciences Centre, ongoing education of house staff by pharmacists is recommended. Among the patients treated at this institution during this study, the most commonly identified organisms causing community-acquired pneumonia were S. pneumoniae and H. influenzae, and the cure rate was 82%. Fluoroquinolone monotherapy selected as initial empiric therapy was significantly less expensive than appropriate non-guideline-based therapy. Therefore, on the basis of efficacy, cost, clinical outcome, and patterns of microbiological culture and sensitivity data and in the absence of any new published guidelines during the period this study was conducted, we concluded that there was no need for revision of institutional guidelines for the management of patients admitted for treatment of community-acquired pneumonia at this tertiary care teaching hospital. However, since this study was conducted, new
North American guidelines for the management of community-acquired pneumonia have been published, and the Sunnybrook treatment algorithm for patients admitted to hospital was modified in March 2007 to reflect these new guidelines. The treatment pathways now offered include IV ceftriaxone plus IV or oral azithromycin or IV or oral levofloxacin at a dose of 750 mg (previously 500 mg) administered at an interval determined by renal function. The results of the study reported here highlight the importance of conducting a quality assurance study to identify whether evidence-based guidelines for community-acquired pneumonia that have been implemented at an institution are actually being used. Furthermore, when considering the need to revise institution-specific recommendations for the treatment of patients with community-acquired pneumonia who must be admitted to hospital, and in the absence of recently published guidelines, it is important to evaluate institution-specific patient characteristics; patterns, duration, appropriateness, clinical outcome, and cost of antimicrobial therapy; and results of microbiological culture. canadian pharmacy online