Antimicrobial therapy of CAP is an important aspect of antimicrobial stewardship, with the aim to minimize antimicrobial consumption and improve clinical outcomes. Aetiology, acquisition, risk factors, and severity assessment should be taken into account to optimize antibiotic therapy.
A number of techniques can be implemented to decrease antimicrobial duration, discontinue unnecessary coverage, and appropriately de-escalate antimicrobial therapy. These include prompt MRSA nares screening, PCR testing of respiratory samples, and cascade reporting of antimicrobial susceptibility reports.
Community-acquired pneumonia (CAP) is the most common infection diagnosis in hospitalized patients, and the majority of CAP patients are treated with antibiotics. According to evidence, 5-7 days of antimicrobial therapy should be sufficient for most patients with CAP; however, many receive much longer courses than this.
One approach is to use procalcitonin (PCT) as a de-escalation tool, which is particularly beneficial in the intensive care unit (ICU). PCT is less sensitive than a traditional culture for identifying systemic infections; therefore, clinicians should be cautious with interpretation when using PCT as an indicator of infection.
Another strategy that has been shown to be effective is the use of a rapid multiplex polymerase chain reaction (PCR)-based respiratory pathogen panel in conjunction with active antimicrobial stewardship. This strategy is known to decrease time to appropriate antibiotic therapy and optimize patient outcomes, such as decreased mortality and morbidity.
In the setting of CAP, antimicrobial therapy may be considered necessary for the proper management of patients. However, there are several factors that can negatively affect the safety of antibiotic use. One such factor is a patient’s risk of developing an opportunistic infection. Another factor is a patient’s ability to respond to treatment.
In addition, antimicrobial stewardship should be conducted in the context of a hospital’s overall stewardship program. This can include obtaining leadership commitment from the chief medical officer, pharmacy director, and nursing leaders to ensure the implementation of antibiotic stewardship efforts.
The tolerability of antimicrobial therapy for CAP in adults is important for clinical success and the prevention of relapse and mortality. Prolonged courses of inappropriate antibiotic treatment can lead to poor outcomes, problems with adherence, and selection of resistant organisms, which are all significant health care costs.
Stewardship of antimicrobial use is a complex, systematic approach to optimizing the effectiveness and safety of antibiotic therapy. Its goal is to maximize patient outcomes, minimize the emergence of resistance, and realize an economic benefit. To achieve this goal, antimicrobial stewardship programs are conducted at a large number of hospitals worldwide. At Nebraska Medicine, an Antimicrobial Stewardship program has been in place since August 2004.
In this study, we retrospectively analyzed empirical antimicrobial regimens for episodes of CAP that received empirical therapy between 2013 and 2020. We applied CRB65-criteria to assess disease severity at presentation and stratified these episodes into 0-1 (narrow spectrum beta-lactams only), 2 or 3-4 categories.
In light of the rising occurrence of multidrug-resistant pathogens, critical care practitioners must develop an enduring understanding of antibiotic stewardship as a core competency in their practice. This requires an interdisciplinary approach that addresses the fear of inadequate empirical treatment, the adverse effects of excessive antibiotic treatment on the individual patient, and a shift in emphasis from cost-saving antibiotic de-escalation efforts to improving overall antibiotic use.
One potential area of antibiotic stewardship is the use of respiratory pathogen panels (RPPs) to aid in the diagnosis and management of patients with CAP. In the context of active stewardship, RRPs have been shown to decrease time to appropriate therapy, optimize economic outcomes, and reduce healthcare costs.
