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Observational Study
. 2022 Oct 14;22(1):379.
doi: 10.1186/s12890-022-02178-6.

Antimicrobial therapy of community-acquired pneumonia during stewardship efforts and a coronavirus pandemic: an observational study

Bjørn Waagsbø  1   2 , Morten Tranung  3   4 , Jan Kristian Damås  5   6 , Lars Heggelund  7   8
Affiliations
Observational Study

Antimicrobial therapy of community-acquired pneumonia during stewardship efforts and a coronavirus pandemic: an observational study

Bjørn Waagsbø et al. BMC Pulm Med. .

Abstract

Background: Community-acquired pneumonia (CAP) is the most frequent infection diagnosis in hospitals. Antimicrobial therapy for CAP is depicted in clinical practice guidelines, but adherence data and effect of antibiotic stewardship measures are lacking.

Methods: A dedicated antibiotic team pointed out CAP as a potential target for antimicrobial stewardship (AMS) measures at a 1.000-bed, tertiary care, teaching university hospital in Norway from March until May for the years 2016 throughout 2021. The aim of the AMS program was to increase diagnostic and antimicrobial therapy adherence to national clinical practice guideline recommendations through multiple and continuous AMS efforts. Descriptive statistics were retrospectively used to delineate antimicrobial therapy for CAP. The primary outcomes were proportions that received narrow-spectrum beta-lactams, and broad-spectrum antimicrobial therapy.

Results: 1.112 CAP episodes were identified. The annual proportion that received narrow-spectrum beta-lactams increased from 56.1 to 74.4% (p = 0.045). Correspondingly, the annual proportion that received broad-spectrum antimicrobial therapy decreased from 34.1 to 17.1% (p = 0.002). Trends were affected by the coronavirus pandemic. Mortality and 30-day readmission rates remained unchanged. De-escalation strategies were frequently unutilized, and overall therapy duration exceeded clinical practice guideline recommendations substantially. Microbiologically confirmed CAP episodes increased from 33.7 to 56.2% during the study period.

Conclusion: CAP is a suitable model condition that is sensitive to AMS measures. A continuous focus on improved microbiological diagnostics and antimicrobial therapy initiation is efficient in increasing adherence to guideline recommendations. There is an unmet need for better antimicrobial de-escalation strategies.

Keywords: Aetiology; Antimicrobial stewardship; Antimicrobial therapy; Community-acquired pneumonia; Microbiology; Pneumonia.

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Conflict of interest statement

Author Bjørn Waagsbø is a representative to the directory group in the Norwegian Directorate of Health that seek to revise recommendations in the national clinical practice guideline for antimicrobial therapy.

Figures

Fig. 1
Fig. 1
Proportions of empirical regimens for CAP per year
Fig. 2
Fig. 2
Definite CAP aetiology per year
Fig. 3
Fig. 3
Empirical antimicrobial therapy stratified by CRB65-category. Abbrevations: nsβ-L = narrow-spectrum betalactam, AMG = aminoglycoside, bsA = broad-spectrum antimicrobial
Fig. 4
Fig. 4
Antimicrobial therapy duration stratified by years, antimicrobial therapy, aetiology and disease severity
See this image and copyright information in PMC

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