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Inpatient care of community-acquired pneumonia: DISCUSSION (1)

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We consider our experience with the inpatient treatment of CAP to be generalizable to similar contemporary populations in other Canadian centres. The cohort was composed of elderly patients (mean age 78 years) with a high risk of mortality (mean PSI score 116, class 4), reflecting the aging patient population and high illness acuity seen in patients admitted urgently to acute care hospitals. Our broad definition of CAP allows for the results to be generalizable by taking into account the diagnostic uncertainty in patients with high rates of cardiopulmonary disease presenting with acute chest symptoms. The finding of only 61% male patients in our cohort could reflect a bias in case ascertainment; however, a similar male predominance has been reported in other Canadian studies. flovent inhaler

Guideline compliance was high in our study, with over 90% of cases treated according to recommendations. Despite a change in guidelines during the study period, we observed a nonsignificant increase in compliance, from 89% to 92%. The high rates of adherence likely relate to the institutional endorsement of the CAP guidelines, which were incorporated into antimicrobial handbooks distributed among the house staff and attending staff. Feagan et al recently reported rates of CAP guideline adherence in 20 Canadian hospitals. They found an average adherence rate of 80%, with a range of 48% to 100%. Our results compare favourably and would place our institution in the 80th percentile of this group.