Determinants of non-adherence to antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia: a prospective study.

Autor: Markussen DL; Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway. dafi@ihelse.net.; Department of Emergency Medicine, Haukeland University Hospital, 5021, Bergen, Norway. dafi@ihelse.net., Wathne JS; Department of Research and Development, Haukeland University Hospital, Bergen, Norway., Ritz C; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark., van Werkhoven CH; Julius Centre for Health Sciences and Primary Care Health, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands., Serigstad S; Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway., Bjørneklett RO; Department of Emergency Medicine, Haukeland University Hospital, 5021, Bergen, Norway.; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway., Ulvestad E; Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.; Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway., Knoop ST; Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway., Jenum S; Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.; Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway., Grewal HMS; Department of Clinical Science, Bergen Integrated Diagnostic Stewardship Cluster, Faculty of Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.; Department of Microbiology, Haukeland University Hospital, 5021, Bergen, Norway.
Jazyk: angličtina
Zdroj: Antimicrobial resistance and infection control [Antimicrob Resist Infect Control] 2024 Nov 23; Vol. 13 (1), pp. 140. Date of Electronic Publication: 2024 Nov 23.
DOI: 10.1186/s13756-024-01494-2
Abstrakt: Background: Antimicrobial resistance (AMR) is a global health threat with millions of deaths annually attributable to bacterial resistance. Effective antimicrobial stewardship programs are crucial for optimizing antibiotic use. This study aims to identify factors contributing to deviations from antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia (CAP).
Methods: We conducted a prospective study at Haukeland University Hospital's Emergency Department in Bergen, Norway, from September 2020 to April 2023. Patients were selected from two cohorts, with data on clinical and microbiologic test results collected. We analysed adherence of antibiotic therapy to guidelines for the choice of empirical treatment and therapy duration using multivariate regression models to identify predictors of non-adherence.
Results: Of the 523 patients studied, 479 (91.6%) received empirical antibiotic therapy within 48 h of admission, with 382 (79.7%) adhering to guidelines. However, among the 341 patients included in the analysis of treatment duration adherence, only 69 (20.2%) received therapy durations that were consistent with guideline recommendations. Key predictors of longer-than-recommended therapy duration included a C-reactive protein (CRP) level exceeding 100 mg/L (RR 1.37, 95% CI 1.18-1.59) and a hospital stay longer than two days (RR 1.22, 95% CI 1.04-1.43). The primary factor contributing to extended antibiotic therapy duration was planned post-discharge treatment. No significant temporal trends in adherence to treatment duration guidelines were observed following the publication of the updated guidelines.
Conclusion: While adherence to guidelines for the choice of empirical antibiotic therapy was relatively high, adherence to guidelines for therapy duration was significantly lower, largely due to extended post-discharge antibiotic treatment. Our findings suggest that publishing updated guidelines alone is insufficient to change clinical practice. Targeted stewardship interventions, particularly those addressing discharge practices, are essential. Future research should compare adherence rates across institutions to identify factors contributing to higher adherence and develop standardized benchmarks for optimal antibiotic stewardship. Trial registration NCT04660084.
Competing Interests: Declarations. Ethics approval and consent to participate: The study is approved by the Regional Committee for Medical and Health Research Ethics in South East Norway (REK ID: 31935) and performed in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants or their legal guardian/close relative at the time of recruitment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje