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. 2021 Nov;49(11):3000605211058366.
doi: 10.1177/03000605211058366.

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study

Lawless Robert  1   2 , Vickers Mark  1   2 , Alawami Moayed  1   2 , Appasamy Nivashen  1   2 , Rajasingam Vinod  1   2 , Paviour Sophie  3   4 , El Washahy Mohamed  1 , Chew Rusheng  1   5
Affiliations

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study

Lawless Robert et al. J Int Med Res. 2021 Nov.

Abstract

Objective: We aimed to assess prescribing practices, compliance with guidelines, and outcomes for patients who were admitted to the authors' institution with community-acquired pneumonia (CAP).

Methods: We performed a single-center retrospective cross-sectional study of adults with CAP presenting during the 2019 influenza season. CAP severity was assessed using the CURB-65 risk score. The effect of CURB-65 risk score use on the rate of appropriate antimicrobial prescribing was assessed using the chi-square test and reported as odds ratio (OR). Fisher's exact test was used to assess the relationship between prescribing appropriateness and patient outcomes.

Results: Patients with low-risk CAP were most likely to be inappropriately prescribed antimicrobials (OR: 4.77; 95% confidence interval: 2.44-10.47). In low-risk CAP, the most common prescribing error was overuse of ceftriaxone. In high-risk CAP, the most common errors were ceftriaxone underdosing and missed atypical coverage with azithromycin. Overall, 80% of patients were considered to have been inappropriately prescribed antimicrobials. No effect on mortality was observed.

Conclusions: In this study, we found low use of CAP risk scores and low adherence to antimicrobial prescribing guidelines for CAP at the authors' institution.

Keywords: Pneumonia; anti-bacterial agent; antimicrobial stewardship; emergency medicine; practice guidelines; respiratory medicine.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of patients diagnosed with community-acquired pneumonia during a single influenza season at a tertiary Australian Hospital in 2019, with reasons for exclusion from the study. COPD, chronic obstructive pulmonary disease.
Figure 2.
Figure 2.
Proportion of included patients considered to have received appropriately versus inappropriately prescribed antibiotic therapy for community-acquired pneumonia during a single influenza season at a tertiary Australian hospital in 2019, according to CURB-65 risk scores.
Figure 3.
Figure 3.
Distribution of reasons for classification as inappropriately prescribed antibiotic therapy for community-acquired pneumonia during a single influenza season at a tertiary Australian hospital in 2019, according to CURB-65 risk scores. eTG, electronic Therapeutic Guidelines.
See this image and copyright information in PMC

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