A majority of patients with community-acquired pneumonia (CAP) receive antibiotics. According to the evidence, 5-7 days of treatment should be sufficient for most patients. Many, however, are treated longer than recommended. We have previously conducted a quality improvement study to ensure guideline-conform treatment for CAP. However, the impact of the interventions on antibiotic use has not been investigated.
To estimate the impact of an eight-month stewardship programme on antibiotic use.
We conducted a before-after study comparing a four-month baseline period with data from a corresponding follow-up period. We performed univariable and multivariable logistic regression comparing odds for ≤7 days of total antibiotic treatment, ≤3 days of intravenous treatment and the proportion of correct empiric antibiotics. As sensitivity analysis, we repeated the univariable logistic regression on a propensity-score matched cohort using the same variables we used for adjustments in the multivariable analysis. We also performed subgroup analyses for patients stable ≤72 hours of admission.
In total, 771 patients were included. Compared to pre-intervention, the unadjusted odds ratio (OR) for ≤7 days of total antibiotic treatment was 1.84 (95%CI 1.34-2.54) for the whole population and 2.08 (1.41-3.10) for the stable patients. The OR for ≤3 days of intravenous antibiotics were 1.16 (0.87-1.54) and 1.38 (0.87-2.22), respectively. The OR for correct empiric antibiotics was 1.96 (1.45-2.68) and 1.82 (1.23-2.69). Comparable results regarding all outcomes were derived from the other analyses.
The programme resulted in a significantly lower overall antibiotic exposure and a higher proportion of patients treated with the recommended antibiotics without reducing the exposure to intravenous antibiotics significantly.

Copyright © 2020. Published by Elsevier Ltd.