Adherence to antibiotic guidelines in the management of community-acquired pneumonia requiring admission

Introduction

Community-acquired pneumonia (CAP) is a common cause of hospitalisation and is associated with significant morbidity and mortality in older adults.  Early management requires timely administration of appropriate antibiotics in line with local guidelines. The CURB-65 score is a validated risk stratification tool recommended by the British Thoracic Society (BTS) and National Institute for Health and Care Excellence (NICE) to guide antibiotic therapy. This audit aimed to assess compliance with national and local guidelines for documentation of CURB-65 scores and appropriate antibiotic prescribing in adults admitted with CAP via the Emergency Department (ED).

Method

A retrospective audit was conducted in a district general hospital ED. Adult patients admitted with CAP over a three-month period were identified from electronic records (median age 83.5 years). Standards were derived from national (BTS/NICE) and local antimicrobial guidelines. Data collected included CURB-65 documentation and adherence to antibiotic guidelines.

A multimodal intervention was implemented, including educational teaching and distribution of visual prompt posters promoting use of the Eolas Medical app. A re-audit was subsequently undertaken.

Results 

A total of 34 patients with radiologically confirmed CAP were included. Baseline CURB-65 documentation was 55.9%. Of these, 26.3% received guideline-concordant antibiotics; this was 14.7% when CURB-65 scores were calculated retrospectively. Co-amoxiclav was frequently over-prescribed. Following intervention, an initial re-audit of 10 patients showed CURB-65 documentation of 70%. Antibiotic adherence was 20% using both documented and retrospectively calculated CURB-65 scores. Co-amoxiclav remained frequently over-prescribed. 

Conclusions

Adherence to antibiotic guidelines in older adults admitted with CAP remained suboptimal. Although documentation of CURB-65 improved following intervention, appropriate antibiotic prescribing remained poor, highlighting the need for continued antimicrobial stewardship to optimise care for older adults with CAP.