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

Abstract

Objectives: Hospitalisations with community-acquired pneumonia (CAP) are often not managed in accordance with antimicrobial guidelines. This study aimed to assess whether guideline-driven antimicrobial prescribing for CAP can be improved using an intervention bundle. Secondary measures assessed were hospital length of stay (LOS), mortality, duration of intravenous antibiotics and total antibiotics, improved uptake of appropriate investigations, and documentation of CURB-65 score. Methods: A retrospective cohort of hospitalised CAP patients from August–September 2018 was compared with a post-intervention prospective cohort from May–June 2019. The intervention bundle included a mobile audience response system, promotion of the antimicrobial app, development of a physical card with local guidelines, and incorporating CURB-65 into the unscheduled admission proforma. Local guidelines are in keeping with British Thoracic Society CAP guidelines. Results: A total of 69 adult patients (aged >18 years) were included in the study (37 retrospective, 32 prospective). Overall compliance with local CAP guidelines improved from 21.6% to 62.5% (P < 0.001). No difference in initial intravenous antibiotic duration was seen (median 4 days vs. 4 days; P = 0.70) and total antibiotic duration was significantly shorter in the post-intervention group (median 9 days vs. 7 days; P = 0.01). No difference in LOS or mortality was seen between the groups. Documentation of CURB-65 improved from 5.4% to 46.9% (P < 0.001). Uptake of streptococcal urinary antigen testing improved from 18.9% to 40.6% (P = 0.024). Conclusions: A simple, low-cost quality improvement bundle can significantly increase appropriate antimicrobial prescribing and shorten the total antibiotic duration.

Keywords

• Community-acquired pneumonia
• Mobile audience response system
• Antimicrobial stewardship