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[Community-acquired pneumonia: from national recommendations to regional standards].

UNLABELLED
Community-acquired pneumonia (CAP) is a major challenge facing health service. The aim of this work was to estimate the effectiveness of introduction of Sverdlovsk region territorial CAP standards into clinical practice in 2002-2011.


MATERIALS AND METHODS
Retrospective analysis included 523 case histories of the patients who diedfrom CAP and 127 one who recovered after treatment (groups 1 and 2 respectively). The primary end-point was general and intrahospital mortality rate, secondary end-points the day of admission to the intensive therapy unit (ITI) and the onset of starting antibiotic therapy (ABT), conformity of ABT to the regional standard. Independent and patient/hospital-dependent risk factors of unfavourable outcome of CAP were subjected to statistical analysis.


RESULTS
In 2002-2011 mortality rate among the able-bodied population and hospitalized patients with CAP decreased by 46 and 15.4% respectively (overall 30.7%). Chronic alcoholism, poor social status (to 53.9 +/- 2.4%), late application for medical aid (77% of the patients applied later than 3 days after the onset of CAP) were risk factors of unfavourable outcome. The time of CAP onset in groups 1 an d 2 was 5.7 +/- 10.3 and 2.2 +/- 4.5 hr respectively (OR: 5.31 [95% CI 2.32 = 12.16] p < 0.01). ABT conformed with the regional standards in 7.4 and 92.1% of the cases in groups I and 2.


CONCLUSION
Strict compliance with national guidelines and regional programs ensures success of diagnostics and treatment of CAR