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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt


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.

TidsskriftInternational Journal of Infectious Diseases
Sider (fra-til)208-213
Antal sider6
StatusUdgivet - feb. 2021

Bibliografisk note

Funding Information:
Dr Benfield reports grants from Pfizer, Novo Nordisk Foundation, Simonsen Foundation, Lundbeck Foundation, Kai Hansen Foundation outside the submitted work; grants and personal fees from GSK, Pfizer, and Gilead outside the submitted work; personal fees from Boehringer Ingelheim, MSD outside the submitted work. Dr. Ravn reports personal fees from Novartis Healthcare A/S, MSD Denmark ApS, CSL Behring GmbH, and Takeda Pharma A/S outside the submitted work. The other authors do not report any conflicts of interest.

Funding Information:
The optiCAP study was funded by The Danish Ministry of Health and by the participating hospitals. The funders had no role in study design, data collection and analysis, decision to publish, or the preparation of the manuscript.

Publisher Copyright:
© 2020 The Author(s)

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