Monday, July 19, 2010

So ya think you're pretty smart about HCAP?

Surveyed docs weren't as smart as they thought in this study:

Surveys were sent to 1313 physicians with a response rate of 65% (n=855). Respondents included physicians in the following categories: hospital medicine/internal medicine, 60%; emergency medicine, 25%; and critical care, 13%. Respondents selected guideline‐concordant antibiotic regimens 78% of the time for CAP, but only 9% of the time for HCAP. Because mean scores for HCAP questions were extremely low (mean, 0.63 correct answers out of 7), differences in performance between groups were too small to be meaningful. Despite their poor performance, 71% of the respondents stated that they are aware of published guidelines for HCAP, and 79% stated that they agree with and practice according to the guidelines.

A related piece in ACP Hospitalist has a very helpful discussion of the nuances of conforming to the guidelines for HCAP. Important issues are patient categorization and appropriate de-escalation. Cultures are often not helpful in de-escalation, so the decision is a judgment call. The trend is to narrow coverage at 24-48 hours in patients who improve rapidly, but the question always nags: when patients get better rapidly is it because of or in spite of the broad spectrum antibiotics?

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