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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
Fésüs Adina Fésüs Adina 1*Baluku Phiona Baluku Phiona 1*Sipos Eva Sipos Eva 1*Somodi Sándor Somodi Sándor 2*Berczi-Kun Enikő Berczi-Kun Enikő 1Istvan Lekli Istvan Lekli 1Ildikó Bácskay Ildikó Bácskay 1*Benkő Ria Benkő Ria 3,4*Vaskó Attila Vaskó Attila 5*
  • 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

The final, formatted version of the article will be published soon.

    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

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.