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ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacology of Infectious Diseases
Volume 15 - 2024 |
doi: 10.3389/fphar.2024.1406960
The Effect of Antibiotic Stewardship Program (ASP) on Community Acquired Pneumonia (CAP): before-after study
Provisionally accepted- 1 Faculty of Pharmacy, University of Debrecen, Debrecen, Hungary
- 2 Department of Emergency and Oxyology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- 3 Albert Szent Györgyi Medical Centre, University of Szeged, Szeged, Iceland
- 4 Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
- 5 Department of Pulmonology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Background: Community-acquired pneumonia (CAP) is still one of the leading causes of death worldwide. Implementation of the Antibiotic Stewardship Program (ASP) aimed to improve the correct and responsible antibiotic use by encouraging guideline adherence. Objective: This retrospective observational before-after study aimed to evaluate whether the ASP may improve guideline adherence, antibiotic exposure and clinical outcomes in patients hospitalized with CAP in Hungary. Methods:The study was conducted at a Pulmonology Department of a tertiary care medical centre in Hungary. The ASP implementation consisted of written and published guidelines available to all professionals, continuous supervision and counselling service on antibiotic therapies at an individual level, with the aim to ensure compliance with CAP guidelines. Overall guideline adherence (agent selection, route of administration, dose), clinical outcomes (length of stay, 30-day mortality), antibiotic exposure and direct costs were compared between the two periods. Fisher's exact test and t-test were applied to compare categorical and continuous variables, respectively. Results: Significant p values were defined as below 0.05. Significant improvement in overall CAP guideline adherence (30.2%), sequential therapy (10.5%) and significant reduction in the total duration of antibiotic therapy (13.5%) were observed. Guideline non-adherent combination therapies with metronidazole decreased significantly by 28.1%. Antibiotic exposure decreased by 7.2% leading to a significant decrease of direct costs (23.6%). Moreover, ASP had benefits on clinical outcomes, length of stay decreased by 13.5% and 30day survival increased by 5.9%. Conclusion: ASP may play an important role in optimizing empirical antibiotic therapy in CAP having a sustained long-term effect.
Keywords: community acquired pneumonia, Hospitalized patients, Empirical antibiotic therapy, antibiotic stewardship, clinical outcomes, intervention
Received: 25 Mar 2024; Accepted: 23 Jul 2024.
Copyright: © 2024 Adina, Phiona, Eva, Sándor, Enikő, Lekli, Bácskay, Ria and Attila. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Fésüs Adina, Faculty of Pharmacy, University of Debrecen, Debrecen, 4032, Hungary
Baluku Phiona, Faculty of Pharmacy, University of Debrecen, Debrecen, 4032, Hungary
Sipos Eva, Faculty of Pharmacy, University of Debrecen, Debrecen, 4032, Hungary
Somodi Sándor, Department of Emergency and Oxyology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
Ildikó Bácskay, Faculty of Pharmacy, University of Debrecen, Debrecen, 4032, Hungary
Benkő Ria, Albert Szent Györgyi Medical Centre, University of Szeged, Szeged, Iceland
Vaskó Attila, Department of Pulmonology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
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