Background and Importance Community-acquired pneumonia (CAP) is still one of the leading causes of death worldwide. In our previous studies, the guideline adherence to national and international CAP guidelines in terms of agent choice was found to be poor. Implementation of the Antibiotic Stewardship Programme (ASP) aimed to improve the correct and responsible antibiotic use by encouraging guideline adherence.

Aim and Objectives This retrospective observational before-after study aimed to evaluate whether the ASP may improve guideline adherence, antibiotic exposure and clinical outcomes in patients hospitalised with CAP in Hungary.

Material and 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. The intervention was performed by a multidisciplinary antibiotic stewardship team (AST) 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-LOS, 30-day mortality), and antibiotic exposure were compared between the pre-intervention and ASP periods (both retrospective observational). Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. Significant p values were defined as below 0.05.

Results Significant improvement in overall CAP guideline adherence (by 30.2%, from 46.6% to 76.8%, p=0.017) and significant reduction in the total duration of antibiotic therapy (by 13.5%, 7.58±3.83 vs. 6.15±3.72 days, p=0.002) were observed. Guideline non-adherent combination therapies with metronidazole decreased significantly by 28.1% (from 31.1% to 3.0%, p<0.001). Antibiotic exposure decreased by 7.2% (from 17.9±10.64 to 15.47±11.03 DDD/patient, p=0.061) and sequential therapy increased significantly by 10.5% (from 3.9% to 14.14%, p=0.01). Moreover, ASP had benefits on clinical outcomes (LOS: decreased by 13.5%, from 8.85±6.1 to 7.09±5.84 days, p=0.016; 30-day survival: increased by 5.9%, from 72.5% to 78.4%, p=0.711).

Conclusion and Relevance Availability of written protocols on the ward and the continuous counselling service is crucial in optimising antibiotic use. Implementation of ASP led to a significant improvement in CAP guideline adherence and sequential therapy, that also entailed the significant reduction of total duration of antibiotic therapy, and length of stay.

Conflict of Interest No conflict of interest.