An audit of community-acquired pneumonia antimicrobial compliance using an intervention bundle in an Irish hospital

O’Kelly, Brendan; Rueda-Benito, Ana Isabel; O’Regan, Mary; Finan, Katherine

doi:10.1016/j.jgar.2020.07.021

Cited by 9 publications

(17 citation statements)

References 25 publications

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“…13 The 2018 eTG updates saw an increase in high-risk CAP ceftriaxone dosing from 1 g daily to 2 g daily; our findings may reflect either a delay in this change in clinical practice or inadequate CAP risk assessment, which seems to be apparent in other data. 4,5,[10][11][12]14,15 In our cohort, the documented use of any pneumonia severity score was low at 4%. In the Australian studies by Maxwell et and 6%, respectively; the authors argued that this reflected a lack of awareness about this tool.…”

Section: Discussionmentioning

confidence: 60%

“…4,11,12 The most common reason for inappropriate prescribing identified by O'Kelly et al was the overuse of amoxicillin with clavulanate. 10 We similarly found that amoxicillin with clavulanate was the most common non-eTG-recommended antibiotic, despite the eTG advising directly against its use owing to the lower daily dose of amoxicillin, the active component against S. pneumoniae, as compared with amoxicillin 1 g three times daily. 4 In addition to its broader spectrum, this contributes to the development of antibiotic resistance.…”

Section: Discussionmentioning

confidence: 93%

“…found that 22% of prescribing was aligned with national standards. 10 – 12 Although the pneumonia severity index (PSI) was used, Maxwell et al. and McIntosh et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 Several other studies have demonstrated similarly low documented use of pneumonia severity scores between 0.4% and 12%, despite these tools being clinically validated and embedded in the guidelines. 5 , 10 , 12 , 14 , 15 The poor compliance with guidelines in the context of a lack of severity risk assessment potentially indicates that the low use of standardized tools leads to misclassification of pneumonia severity and consequently contributes to inappropriate prescribing. This is likely reflected in the high prevalence of additional non-indicated antimicrobial prescribing in patients with low- and moderate-risk CAP and missed antimicrobial prescribing in high-risk CAP.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 93%

“…found that 22% of prescribing was aligned with national standards. 10 – 12 Although the pneumonia severity index (PSI) was used, Maxwell et al. and McIntosh et al.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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A Service Evaluation of Adherence with Antimicrobial Guidelines in the Treatment of Community-Acquired Pneumonia Before and During the SARS-CoV-2 Outbreak

Howley

Keating

Kelly

et al. 2022

SN Compr. Clin. Med.

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Antimicrobial stewardship is essential to reducing antimicrobial resistance, reducing costs, and, crucially, ensuring good patient care. Community-acquired pneumonia (CAP) is a common medical condition, the symptoms of which show a significant overlap with those of COVID-19. Following the COVID-19 outbreak in Ireland, patients presenting to our hospital with features of a respiratory infection were more commonly reviewed within 24 hours (24h) of admission by an infectious disease (ID) or respiratory specialist. We aimed to assess how the change in service provision, involving frequent specialist reviews of patients admitted with features of CAP during the first wave of the COVID-19 pandemic, affected antimicrobial stewardship and prescribing practices. Patients admitted under general medical teams treated for CAP from March-April 2020 were included. Retrospective data including demographics, CURB-65 score, and antimicrobial therapy were collected, as well as information on whether the patient had undergone specialist review by an ID or respiratory physician. Data were compared to a similar cohort treated for CAP between November 2019 and January 2020, though in this cohort, before the era of COVID-19, none of the patients had undergone specialist review. Seventy-six patients were included from the March-April 2020 cohort, with 77 from November 2019-January 2020 for comparison. An ID or respiratory specialist reviewed 35 patients from the March-April cohort within 24 h of admission. There was a higher rate of appropriate escalation, de-escalation, and continuation of antibiotics among those reviewed. Less than 20% of patients were started on antibiotics in accordance with CAP guidelines on admission, though the antibiotics initiated were frequently deemed appropriate in the clinical setting. Specialist review increases rates of appropriate antimicrobial prescribing and adherence with hospital guidelines in patients with CAP.

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Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data

Higgins,

Freeman,

Doble

et al. 2023

Journal of Hospital Infection

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An audit of community-acquired pneumonia antimicrobial compliance using an intervention bundle in an Irish hospital

Cited by 9 publications

References 25 publications

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

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

A Service Evaluation of Adherence with Antimicrobial Guidelines in the Treatment of Community-Acquired Pneumonia Before and During the SARS-CoV-2 Outbreak

Appropriateness of acute-care antibiotic prescriptions for community-acquired infections and surgical antibiotic prophylaxis in England: analysis of 2016 national point prevalence survey data

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