Determinants of non-adherence to antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia: a prospective study

• Published in: Antimicrobial resistance & infection control Vol. 13; no. 1; pp. 140 - 18
• Main Authors: Markussen, Dagfinn Lunde, Wathne, Jannicke Slettli, Ritz, Christian, van Werkhoven, Cornelis H, Serigstad, Sondre, Bjørneklett, Rune Oskar, Ulvestad, Elling, Knoop, Siri Tandberg, Jenum, Synne, Grewal, Harleen M S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.11.2024; BioMed Central; BMC
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotic stewardship; Antibiotic therapy duration; Antimicrobial resistance (AMR); Antimicrobial Stewardship; Community-Acquired Infections - drug therapy; Community-acquired pneumonia (CAP); COPD; Drug resistance in microorganisms; Female; Guideline Adherence; Health aspects; Hospital patients; Hospitalization; Humans; Male; Medical research; Medicine, Experimental; Middle Aged; Norway; Patient compliance; Pneumonia - drug therapy; Practice guidelines (Medicine); Practice Guidelines as Topic; Prospective Studies; Tetracycline; Tetracyclines; World health; Norway; Denmark; Empirical antibiotic therapy; Guideline adherence; Antimicrobial resistance (AMR); Hospital discharge practices; C-reactive protein (CRP); Community-acquired pneumonia (CAP); Antibiotic stewardship; Antibiotic therapy duration; COPD
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-024-01494-2

Antimicrobial resistance (AMR) is a global health threat with millions of deaths annually attributable to bacterial resistance. Effective antimicrobial stewardship programs are crucial for optimizing antibiotic use. This study aims to identify factors contributing to deviations from antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia (CAP). We conducted a prospective study at Haukeland University Hospital's Emergency Department in Bergen, Norway, from September 2020 to April 2023. Patients were selected from two cohorts, with data on clinical and microbiologic test results collected. We analysed adherence of antibiotic therapy to guidelines for the choice of empirical treatment and therapy duration using multivariate regression models to identify predictors of non-adherence. Of the 523 patients studied, 479 (91.6%) received empirical antibiotic therapy within 48 h of admission, with 382 (79.7%) adhering to guidelines. However, among the 341 patients included in the analysis of treatment duration adherence, only 69 (20.2%) received therapy durations that were consistent with guideline recommendations. Key predictors of longer-than-recommended therapy duration included a C-reactive protein (CRP) level exceeding 100 mg/L (RR 1.37, 95% CI 1.18-1.59) and a hospital stay longer than two days (RR 1.22, 95% CI 1.04-1.43). The primary factor contributing to extended antibiotic therapy duration was planned post-discharge treatment. No significant temporal trends in adherence to treatment duration guidelines were observed following the publication of the updated guidelines. While adherence to guidelines for the choice of empirical antibiotic therapy was relatively high, adherence to guidelines for therapy duration was significantly lower, largely due to extended post-discharge antibiotic treatment. Our findings suggest that publishing updated guidelines alone is insufficient to change clinical practice. Targeted stewardship interventions, particularly those addressing discharge practices, are essential. Future research should compare adherence rates across institutions to identify factors contributing to higher adherence and develop standardized benchmarks for optimal antibiotic stewardship. Trial registration NCT04660084.