Targeting antimicrobial stewardship in hospitalised patients with community-acquired pneumonia within 24?h?of admission

摘要

BackgroundOver-prescribing in patients with respiratory tract infections is common in Australian hospitals. Senior registrar stewardship input within 24?h of admission in hospitalised patients was assessed to determine if this would improve appropriateness.MethodsInterventional, non-randomised, case-controlled study over six-month period. Patients diagnosed with pneumonia admitted under General Medicine were discussed at morning handover and assessed by a senior registrar within the first 24?h of admission with real-time stewardship feedback provided. Controls did not receive stewardship advice. Appropriateness of antibiotic use was assessed using Therapeutic Guidelines.ResultsIn total, 48 patients had an intervention with 49 controls. Ceftriaxone-based regimens were the most commonly prescribed (control 63%; pre-intervention 70%; post-intervention 51%). The senior registrar recommended changes in 26 patients (55%) with 71% uptake of recommendations. The most common recommendation was de-escalation from ceftriaxone-regimen in patients with CORB scores of 0 and 1 (79%; n = 16/20). Post-intervention antibiotic prescribing improved from <5% to 50% in patients with CORB scores of 0 and 1 (p-value <0.05).ConclusionOur results demonstrate that involvement of a senior registrar embedded in the treating team is effective in providing timely advice to influence common hospital over-prescribing in patients with pneumonia. This enhances other antimicrobial stewardship activities such as electronic approval systems and dedicated post-prescribing rounds by Antimicrobial Stewardship team.