Guideline-based treatment for multidrug-resistant disease in ICUs linked to higher risk of death
THURSDAY, Jan. 20 (HealthDay News) -- Mortality rates appear to be higher in intensive care patients at risk for multidrug-resistant (MDR) pneumonia who are treated by a protocol in compliance with current American Thoracic Society and Infectious Diseases Society of America guidelines, according to research published online Jan. 20 in The Lancet Infectious Diseases.
Daniel H. Kett, M.D., of the University of Miami, and colleagues implemented an initiative in four institutions for compliance with pneumonia-related management guidelines, and observed 303 intensive care unit patients at risk for MDR pneumonia and treated empirically to assess compliance with guidelines and outcomes.
The researchers found that guidelines were followed for 129 patients and not followed for 174 patients, and more patients in the compliance group died before day 28 than in the non-compliance group -- 44 (34 percent) compared with 35 (20 percent). The Kaplan-Meier estimate of survival to day 28 was 65 percent for those whose treatment was guideline-compliant and 79 percent for those whose treatment was not. The difference persisted after adjustment for severity of illness.
"Because adherence with empirical treatment was associated with increased mortality, we recommend a randomized trial be done before further implementation of these guidelines," the authors write.
Several authors disclosed financial relationships with pharmaceutical companies, including Pfizer, which funded the study along with U.S. Medical.
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