Guidelines to practice: Addressing regional antimicrobial prescribing gaps in community-acquired pneumonia.

Abstract

Community-acquired pneumonia (CAP) is a major contributor to global disease burden and healthcare costs, ranking as the fourth leading cause of healthy life years lost. In Australia, the annual cost of treating hospitalised CAP exceeds $350 million. Therapeutic Guidelines recommend IV ceftriaxone and azithromycin for high-severity CAP, while alternative regimens are advised for lower severity cases. Misuse of broad-spectrum antibiotics increases the risk of antimicrobial resistance, emphasising the need for adherence to guidelines and the use of validated tools like the CURB-65 score to assess CAP severity. Aim/Objectives: This study aimed to evaluate the prescribing patterns for CAP in a regional hospital, focusing on the use of IV ceftriaxone and azithromycin. The primary objective was to determine the proportion of patients appropriately treated for high-severity CAP as defined by the CURB-65 score. Secondary objectives included assessing the rate of inappropriate prescribing in low-to-moderate severity cases and the frequency of CURB-65 usage and severity documentation. Methods: A retrospective audit was conducted at a 212-bed hospital in regional Victoria, covering the period from January 2022 to May 2024. Adults diagnosed with CAP within 24 hours of admission were included. Data was extracted from medical records and assessed for CURB-65 score, CAP severity classification, and antimicrobial appropriateness according to Therapeutic Guidelines and local protocol. Results: Out of 976 admissions, 228 patients met inclusion criteria. Only 16.6% had high-severity CAP, but 45.2% received the high-severity antibiotic combination. CURB-65 was documented in just 3.1% of cases. While 73.3% of high-severity cases were appropriately treated, 76.4% of low-to-moderate severity patients received inappropriate therapy. Discussion: The findings reveal significant overuse of broad-spectrum antibiotics in low-severity CAP and underutilisation of the CURB-65 tool. Promoting guideline adherence, enhanced documentation, and targeted antimicrobial stewardship interventions are recommended within regional practice to optimise CAP management and combat resistance.