Community acquired pneumonia (CAP) is a common condition with significant morbidity and mortality especially in the elderly. Inappropriate selection of antibiotics has frequently been reported in the literature, including within the Australian setting. Clinical pathways and antimicrobial stewardship (AMS) efforts have been effective tools in the management of CAP, encouraging greater adherence to treatment guidelines and the use of severity assessment tools to guide emperic andtibiotic choice.
A baseline retrospective audit revealed high rates of inappropriate prescribing for CAP outside of established guidelines. This stemmed mainly from the lack of severity assessment to guide empiric therapy. To improve management, a fully integrated CAP clinical pathway for immuno-competent adult patients was designed. The SMART-COP tool was chosen as the severity assessment tool (SAT) as it was well validated in the Australian Community Acquired Pneumonia Study. A random sample of 80 patients with the principal diagnosis of CAP were selected annually from 2013-2015 to measure the effect and sustainability of the intervention.
Use of a SAT was integral in guiding the selection of appropriate antibiotics which has risen from 9% in 2012 to 46% in 2015. The inappropriate use of broad spectrum antibiotics declined since the commencement of the CAP Pathway as seen in the graph below.
The average Length of Stay (LOS) for patients on the CAP pathway has also declined from 7.14 days in 2012 to 4.31 days in 2015. This is significant reduction in healthcare cost associated with the care of patients with CAP. Pneumonia In-Hospital Mortality Variable Life Adjusted Display indicators for Logan Hospital show no persistent flags, indicating no unexpected treatment outcomes.
The implementation of a CAP Pathway has shown continuing improvement in the choice of empiric therapy for the management of CAP with a reduction in the use of inappropriate broad spectrum antibiotics, both intravenous and oral. The average LOS for patients admitted with CAP has also decreased, impacting patient flow within the hospital. This is a significant AMS gain and shows that penicillin plus doxycycline or a macrolide can still be the most appropriate therapy in an Australian setting.
K. Houghton, None
P. Firman, None
Z. Klyza, None
D. McDougall, None