Adherence to Antibiotic Guidelines in Acute Patients With Suspected Severe Pneumonia: A Cohort Study
PDF (English)

Supplerende filer

Supplementary Material (English)

Nøgleord

Pneumonia
Antibiotics
Antimicrobial Stewardship
Guideline Adherence
Community-Acquired Pneumonia

Citation/Eksport

Schjødt, S., Lisby, M., Ebdrup, L., & Jessen, M. K. (2025). Adherence to Antibiotic Guidelines in Acute Patients With Suspected Severe Pneumonia: A Cohort Study. Dansk Tidsskrift for Akutmedicin, 8(1), 36–45. https://doi.org/10.7146/akut.v8i1.156720

Resumé

Introduction: Community-acquired pneumonia (CAP) accounts for a substantial part of antibiotic prescriptions in emergency departments (EDs). Guidelines for empiric antibiotic treatment support rational use of antibiotics and should sharpen the indication and prevent overuse of antibiotics.

Aim: This study aimed to investigate whether ED patients who were prescribed antibiotics for suspected severe pneumonia fulfilled the criteria for the treatment.

Methods: This was a retrospective cohort study. The population consisted of adults hospitalized in two Danish EDs in the Central Denmark Region between July 1, 2022, and June 30, 2023, who were prescribed antibiotic treatment using the Standard Prescription Package: “Start package of severe pneumonia” (SPP-SP), containing piperacillin/tazobactam (Pip/Taz) plus clarithromycin. Review of electronic medical records (EMRs) was performed to decide whether the patients met the criteria for the SPP-SP.

Results: 270 patients were included. In total, 103/270 (38%) patients fulfilled the criteria for treatment with the SPP-SP, whereas 167/270 (62%) patients did not.

Conclusion: The criteria for prescribing antibiotics based on the severe pneumonia prescription package were fulfilled in only 38% of patients, reflecting a deviation in guideline adherence. This study provides useful and practical knowledge for implementation of new guidelines and focus areas in line with Antibiotic Stewardship.

https://doi.org/10.7146/akut.v8i1.156720
PDF (English)

Referencer

Plouffe JF, Martin DR. Pneumonia in the emergency de-partment. Emerg Med Clin North Am.26(2):389-411, ix. DOI: 10.1016/j.emc.2008.02.005.

Statens Serum Institut. Lungebetændelse. https://www.ssi.dk/sygdomme-beredskab-og-forskning/sygdomsleksikon/l/lungebetaendelse. [access date: 07 jul. 2025].

Amati F, Bindo F, Stainer A, Gramegna A, Mantero M, Ni-gro M, et al. Identify Drug-Resistant Pathogens in Pa-tients with Community-Acquired Pneumonia. Adv Respir Med.91(3):224-38. DOI: 10.3390/arm91030018.

Bush K, Bradford PA. β-Lactams and β-Lactamase Inhibi-tors: An Overview. Cold Spring Harb Perspect Med. 2016;6(8)DOI: 10.1101/cshperspect.a025247.

DANMAP 2022: Use of antimicrobial agents and oc-curence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. ISSN 1600-2032. Copenhagen, Denmark: National Food Institute, Statens Serum Institut; 2022.

Tarp BD, Greve T. Pneumoni (CAP), regional retningslin-je, vers. nr: 18 (2023). https://e-dok.rm.dk/edok/Admin/GUI.nsf/Desktop.html?open&openlink=https://e-dok.rm.dk/edok/enduser/portal.nsf/Main.html?open&unid=X075DFA66BAC77902C12581CA00458E04&dbpath=/edok/editor/RM.nsf/&windowwidth=1100&windowheight=600&windowtitle=S%F8g. [access date: 21 mar. 2025].

Hagen TL, Hertz MA, Uhrin GB, Dalager-Pedersen M, Schønheyder HC, Nielsen H. Adherence to local antimi-crobial guidelines for initial treatment of community-acquired infections. Dan Med J.64(6).

Cartuliares MB, Søgaard SN, Rosenvinge FS, Mogensen CB, Hertz MA, Skjøt-Arkil H. Antibiotic Guideline Adher-ence at the Emergency Department: A Descriptive Study from a Country with a Restrictive Antibiotic Policy. Anti-biotics (Basel).12(12) DOI: 10.3390/antibiotics12121680.

Eekholm S, Ahlström G, Kristensson J, Lindhardt T. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC Infect Dis.20(1):73. DOI: 10.1186/s12879-019-4742-4.

CDC. The Core Elements of Hospital Antibiotic Steward-ship Programs (2019). https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.pdf. [ac-cess date: 21 mar. 2025].

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) State-ment: guidelines for reporting observational studies. Int J Surg.12(12):1495-9. DOI: 10.1016/j.ijsu.2014.07.013.

Region Midtjylland. Business Intelligence i Region Mid-tjylland. https://www.rm.dk/om-os/organisation/it-og-digitalisering/business-intelligence/. [access date: 07 jul. 2025].

Pant S, Corwin A, Adhikari P, Acharya SP, Acharya U, Sil-wal S, et al. Evaluating Antibiotic Treatment Guideline Adherence to Ongoing Antibiotic Stewardship in a Ter-tiary Care Setting: A Retrospective Observational Study. Can J Infect Dis Med Microbiol.2024:6663119. DOI: 10.1155/2024/6663119.

Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, et al. Vital signs: improving antibiotic use among hos-pitalized patients. MMWR Morb Mortal Wkly Rep. 2014;63(9):194-200.

Fally M, Diernaes E, Israelsen S, Tarp B, Benfield T, Kolte L, et al. The impact of a stewardship program on antibi-otic administration in community-acquired pneumonia: Results from an observational before-after study. Int J In-fect Dis. 2021;103:208-13. DOI: 10.1016/j.ijid.2020.11.172.

Gordon K, Stevens R, Westley B, Bulkow L. Impact of an antimicrobial stewardship program on outcomes in pa-tients with community-acquired pneumonia admitted to a tertiary community hospital. Am J Health Syst Pharm. 2018;75(11 Supplement 2):S42-s50. DOI: 10.2146/ajhp170360.

Høgli JU, Garcia BH, Skjold F, Skogen V, Småbrekke L. An audit and feedback intervention study increased adher-ence to antibiotic prescribing guidelines at a Norwegian hospital. BMC Infect Dis. 2016;16:96. DOI: 10.1186/s12879-016-1426-1.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Con-sensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama.315(8):801-10. DOI: 10.1001/jama.2016.0287.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Fail-ure Assessment) score to describe organ dysfunc-tion/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med.22(7):707-10. DOI: 10.1007/bf01709751.

Tokioka F, Okamoto H, Yamazaki A, Itou A, Ishida T. The prognostic performance of qSOFA for community-acquired pneumonia. J Intensive Care. 2018;6:46. DOI: 10.1186/s40560-018-0307-7.

Fally M, Fischer CP, Engberg JH, Sönksen UW, Benfield T, Jensen J-US. National retningslinje for håndtering af voksne patienter indlagt med pneumoni (2. udgave, 2025). https://infmed.dk/site/tools/download.php?UID=a62510859026afe187b0031e285afcdd849b4633. [access date: 15 apr. 2025].

Tofthagen C. Threats to validity in retrospective studies. J Adv Pract Oncol. 2012;3(3):181-3.

Schouten JA, Hulscher ME, Natsch S, Kullberg BJ, van der Meer JW, Grol RP. Barriers to optimal antibiotic use for community-acquired pneumonia at hospitals: a qualita-tive study. Qual Saf Health Care. 2007;16(2):143-9. DOI: 10.1136/qshc.2005.017327.

Creative Commons License

Dette værk er under følgende licens Creative Commons Navngivelse (by).

Copyright (c) 2025 Sanne Schjødt, Marianne Lisby, Lotte Ebdrup, Marie Kristine Jessen