| Popis: |
Background Antimicrobial resistance (AMR) is a matter of international importance. The UK government launched a 5 year plan to tackle AMR in 2019, aiming to reduce antibiotic use by 15%. NICE guidelines advocate routine microbiological testing only in patients admitted to hospital with community-acquired pneumonia (CAP) with a CURB65 score ≥2. We hypothesise that by introducing front-door comprehensive microbiological testing that a higher proportion of patients will get a microbiological diagnosis, enabling better streamlining of antibiotic regimens. Methods Patients admitted with CAP at Royal Derby Hospital were prospectively reviewed over a 38 month period from February 2016. Comprehensive microbiological testing was attempted where possible within the first 24 hours of admission, comprising point-of-care urinary legionella and pneumococcal antigens, blood and sputum cultures. Influenza PCR was performed during influenza season. All antibiotics prescribed during the admission (including discharge) were recorded. Narrow spectrum (NS) antibiotics were defined as beta-lactam, tetracycline or 1st generation cephalosporin monotherapy; broad spectrum (BS) antibiotics included co-amoxiclav, macrolides and fluoroquinolones. Days were recorded separately in cases where dual antibiotic therapy was used. Results Of 1336 patients admitted with CAP, 375 (28.0%) received a positive microbiological diagnosis, compared with 37/324 (11.4%) in a pre-intervention cohort. Prior to comprehensive screening patients with CAP received a median of 9.5 days (IQR 4.9–13.0) of BS antibiotics compared with 7.8 days (3.3–12.2) after. Within the intervention group, patients with a positive pneumococcal diagnosis (n=265, 19.8%) received a median of 4.0 (IQR 1.5–7.8) days of BS antibiotic and 5.5 days (IQR 2.0–7.0) of NS antibiotic, compared with 8.8 (4.7–12.8) and 0.0 (0–4.3) days respectively for those with no positive microbiology. CURB65 scores were similar between the two groups (pneumococcal group, low severity 132/265 (49.8%); no diagnosis group 480/961 (49.9%)). Median co-amoxiclav use was 1.0 day (0–2.3) in the pneumococcal group compared with 3.3 days (0–6.3) in the group with no positive microbiology. Conclusion Comprehensive microbiological testing results in a higher proportion of patients with a positive microbiological diagnosis, and is associated with lower prescribing of BS antibiotics. |
