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

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@article{42f81f2e0d7e4035bbbbe0892d1708a4,
title = "The impact of a stewardship program 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 program 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 to compare 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 by using the same variables we used for adjustments in the multivariable analysis. We also performed subgroup analyses for patients stable ≤72 h of admission.RESULTS: In total, 771 patients were included. Compared to preintervention, the unadjusted odds ratio (OR) for ≤7 days of total antibiotic treatment were 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 were 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 a the reduction of exposure to intravenous antibiotics significantly.",
keywords = "Antibiotic stewardship, Antibiotic therapy, Community-acquired pneumonia, Healthcare quality",
author = "Markus Fally and Emma Diernaes and Simone Israelsen and Britta Tarp and Thomas Benfield and Lilian Kolte and Pernille Ravn",
note = "Copyright {\textcopyright} 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.",
year = "2021",
month = feb,
day = "1",
doi = "10.1016/j.ijid.2020.11.172",
language = "English",
volume = "103",
pages = "208--213",
journal = "International Journal of Infectious Diseases",
issn = "1201-9712",
publisher = "Elsevier Ltd",

}

RIS

TY - JOUR

T1 - The impact of a stewardship program on antibiotic administration in community-acquired pneumonia

T2 - results from an observational before-after study

AU - Fally, Markus

AU - Diernaes, Emma

AU - Israelsen, Simone

AU - Tarp, Britta

AU - Benfield, Thomas

AU - Kolte, Lilian

AU - Ravn, Pernille

N1 - Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - 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 program 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 to compare 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 by using the same variables we used for adjustments in the multivariable analysis. We also performed subgroup analyses for patients stable ≤72 h of admission.RESULTS: In total, 771 patients were included. Compared to preintervention, the unadjusted odds ratio (OR) for ≤7 days of total antibiotic treatment were 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 were 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 a the reduction of exposure to intravenous antibiotics significantly.

AB - 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 program 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 to compare 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 by using the same variables we used for adjustments in the multivariable analysis. We also performed subgroup analyses for patients stable ≤72 h of admission.RESULTS: In total, 771 patients were included. Compared to preintervention, the unadjusted odds ratio (OR) for ≤7 days of total antibiotic treatment were 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 were 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 a the reduction of exposure to intravenous antibiotics significantly.

KW - Antibiotic stewardship

KW - Antibiotic therapy

KW - Community-acquired pneumonia

KW - Healthcare quality

UR - http://www.scopus.com/inward/record.url?scp=85098208307&partnerID=8YFLogxK

U2 - 10.1016/j.ijid.2020.11.172

DO - 10.1016/j.ijid.2020.11.172

M3 - Journal article

C2 - 33232831

VL - 103

SP - 208

EP - 213

JO - International Journal of Infectious Diseases

JF - International Journal of Infectious Diseases

SN - 1201-9712

ER -

ID: 61340611