An audit of community acquired pneumonia (CAP) antimicrobial compliance using an intervention bundle in an Irish hospital

O’Kelly, B.; Rueda-Benito, A.; O’Regan, M.; Finan, K.

BACKGROUND: Hospitalisations with community acquired pneumonia (CAP) are often not managed in accordance with antimicrobial guidelines. AIM: The aim of this study was to assess if guideline driven antimicrobial prescribing for CAP can be improved using an intervention bundle. Secondary measures assessed were length of stay (LOS), mortality, duration of intravenous antibiotics and total antibiotic duration, improving uptake of appropriate investigations and documentation of CURB65. METHODS: A retrospective cohort of hospitalised CAP patients from August -September 2018 was compared with a post intervention prospective cohort from May-June 2019. Intervention bundle included a mobile audience response session (MARS) session, promotion of the antimicrobial app, development of a physical card with local guidelines and incorporating CURB65 into the unscheduled admission proforma. Local guidelines are in keeping with the British Thoracic Society (BTS) CAP guidelines. RESULTS: 69 adult patients (>18 years old) were included in the study (37 retrospective, 32 prospective). Overall compliance with local CAP guidelines improved from 21% to 62.5% (p < 0.001). No difference in initial intravenous antibiotic duration was seen, median 4 vs 4 days (p = 0.73), total antibiotic duration was significantly shorter in the post intervention group, median 9 vs 7 days (p = 0.01). No difference in length of stay or mortality was seen between the groups. Documentation of CURB65 improved from 5.6% to 46.9% (p < 0.01). Uptake of streptococcal urinary antigen improved from 18.9% to 40.6% (p = 0.024). CONCLUSION: A simple low cost quality improvement bundle can significantly increase appropriate antimicrobial prescribing and shorten total duration of antibiotics.