Targeting antimicrobial stewardship in hospitalised patients with community-acquired pneumonia within 24 h of admission.

Background: Over-prescribing in patients with respiratory tract infections is common in Australian hospitals. Senior registrar stewardship input within 24 h of admission in hospitalised patients was assessed to determine if this would improve appropriateness.

Methods: Interventional, non-randomised, case-controlled study over six-month period. Patients diagnosed with pneumonia admitted under General Medicine were discussed at morning handover and assessed by a senior registrar within the first 24 h of admission with real-time stewardship feedback provided. Controls did not receive stewardship advice. Appropriateness of antibiotic use was assessed using Therapeutic Guidelines.

Results: In total, 48 patients had an intervention with 49 controls. Ceftriaxone-based regimens were the most commonly prescribed (control 63%; pre-intervention 70%; post-intervention 51%). The senior registrar recommended changes in 26 patients (55%) with 71% uptake of recommendations. The most common recommendation was de-escalation from ceftriaxone-regimen in patients with CORB scores of 0 and 1 (79%; n = 16/20). Post-intervention antibiotic prescribing improved from <5% to 50% in patients with CORB scores of 0 and 1 (p-value <0.05).

Conclusion: Our results demonstrate that involvement of a senior registrar embedded in the treating team is effective in providing timely advice to influence common hospital over-prescribing in patients with pneumonia. This enhances other antimicrobial stewardship activities such as electronic approval systems and dedicated post-prescribing rounds by Antimicrobial Stewardship team.