The impact of a stewardship programme on antibiotic administration in community-acquired pneumonia: results from an observational before-after study.

Abstract Background 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. Objective To estimate the impact of an eight-month stewardship programme on antibiotic use. Methods 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. Results 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. Conclusion 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.