Antibiotic stewardship in community-acquired pneumonia

Abstract

Community-acquired pneumonia (CAP) continues to be associated with significant mortality and morbidity. As with other infectious diseases, in recent years there has been a marked increase in resistance to the antibiotics commonly used against the pathogens that cause CAP. Antimicrobial stewardship denotes coordinated interventions to improve and measure the appropriate use of antibiotics by encouraging the selection of optimal drug regimens. Areas covered: Several elements can be applied to antibiotic stewardship strategies for CAP in order to maintain or improve patient outcomes. In this regard, antibiotic de-escalation, duration of antibiotic treatment, adherence to CAP guidelines recommendations about empirical treatment, and switching from intravenous to oral antibiotic therapy may each be relevant in this context. Antimicrobial stewardship strategies, such as prospective audit with intervention and feedback, clinical pathways, and dedicated multidisciplinary teams, that have included some of these elements have demonstrated improvements in antimicrobial use for CAP without negatively affecting clinical outcomes. Expert commentary: Although there are a limited number of randomized clinical studies addressing antimicrobial stewardship strategies in CAP, there is evidence that antibiotic stewardship initiatives can be securely applied, providing benefits to both healthcare systems and patients.

Determining best outcomes from community‐acquired pneumonia and how to achieve them

“…Centres that have introduced care bundles and antibiotic guidelines for CAP have found improvements in readmission rates, hospital and ICU LOS but not clinical outcomes. 28,83 Targets for antimicrobial stewardship programs include increasing the number of patients treated as outpatients, stepping down to oral agents and shortening the duration of antibiotics. 84 Their role is therefore to maintain clinical outcomes whilst improving health care costs, antimicrobial resistance and patient satisfaction.…”

Abstracts zum 126. Kongress der Deutschen Gesellschaft für Innere Medizin e.V.

“…Diskussion: Obwohl die dargestellten Ergebnisse einen klaren Verbesserungsbedarf belegen, spiegeln sie den Versorgungsalltag auch im internationalen Vergleich wieder [Reissig 2013]. Diverse evidenzbasierte Interventionsmöglichkeiten sind in der Literatur beschrieben [Viasus 2017]. Hinsichtlich der Makrolidtherapie ist eine differenzierte Betrachtung notwendig: es wäre wünschenswert, wenn die Leitlinien für die leichte CAP Entscheidungskriterien für eine additive Makrolidtherapie definieren würden; für die schwere CAP sollte herausgestellt werden, dass die Empfehlung zur Kombinationstherapie mit Makroliden aufgrund einer hochsignifikanten Reduktion der Mortalität in einer retrospektiven Studie [Tessmer 2009] Eingang in die S3 Leitlinie gefunden hat.…”

Moving Antibiotic Stewardship from Theory to Practice

“…The literature on treatment of pneumonia is increasingly demonstrating that shorter use of antibiotics is often better. 7 Even though current guidelines recommend 5 to 7 days of antibiotics for uncomplicated community-acquired pneumonia, average durations of therapy are often longer. 8 Previous work published in the Journal of Hospital Medicine focused on improving antimicrobial documentation as well as access to local clinical guidelines and implementing a 72hour antimicrobial "time out" by hospitalists.…”