Management of community-acquired pneumonia in an Australian regional hospital

Objective: Current management of hospitalised patients with community-acquired pneumonia (CAP) in an Australian regional hospital in accordance with the recommended guidelines is unknown. The prescription rate of inappropriate antibiotic therapy was measured and analysed.

Design: A retrospective audit, December 2012 to November 2013.

Setting: Regional Australian hospital in North East Victoria.

Interventions: Interventions were the average of inpatient and intensive care unit length of stay, time to first antibiotic and to first chest X-ray, days of intravenous antibiotics, and extra intravenous therapy; proportion of intensive care unit admissions, average time to first antibiotic administration, patients with failed outpatient management of CAP, initial microbiological investigations, positive investigations, predominant microbiology, antibiotic choice, and concordance with guidelines; proportion of justifiable deviation from guidelines, ratio of patients switched to oral therapy appropriately, complications during therapy, clinical failure, inpatient mortality, mortality at 30 days, mortality at 6 months, and readmission with CAP in 30 days and in 3 months.

Main outcome measures: To improve the rates of concordance with guidelines by following a specified method to rate severity of CAP, to clearly document reasons for non-concordance with guidelines, and to rationalise investigations.

Results: To improve antibiotic stewardship in the management of CAP.

Conclusion: In an Australian regional hospital, ceftriaxone and azithromycin were the predominant combination used at 56%, demonstrating that mild CAP was frequently overtreated. Mild CAP was eight times more likely to be treated as severe CAP (odds ratio = 8.2 (95% confidence interval, 1.7-40.3) P < 0.009). There is a need for a simple yet effective strategy to be introduced to rationalise treatment and investigation of CAP in this setting.