Howley Fergal, Keating Donal, Kelly Mary, O'Connor Roisin, O'Riordan Ruth
Department of General Internal Medicine, St James's Hospital, Dublin, Ireland.
Pharmacy Department, St James's Hospital, Dublin, Ireland.
SN Compr Clin Med. 2022;4(1):225. doi: 10.1007/s42399-022-01311-0. Epub 2022 Oct 13.
Antimicrobial stewardship is essential to reducing antimicrobial resistance, reducing costs, and, crucially, ensuring good patient care. Community-acquired pneumonia (CAP) is a common medical condition, the symptoms of which show a significant overlap with those of COVID-19. Following the COVID-19 outbreak in Ireland, patients presenting to our hospital with features of a respiratory infection were more commonly reviewed within 24 hours (24h) of admission by an infectious disease (ID) or respiratory specialist. We aimed to assess how the change in service provision, involving frequent specialist reviews of patients admitted with features of CAP during the first wave of the COVID-19 pandemic, affected antimicrobial stewardship and prescribing practices. Patients admitted under general medical teams treated for CAP from March-April 2020 were included. Retrospective data including demographics, CURB-65 score, and antimicrobial therapy were collected, as well as information on whether the patient had undergone specialist review by an ID or respiratory physician. Data were compared to a similar cohort treated for CAP between November 2019 and January 2020, though in this cohort, before the era of COVID-19, none of the patients had undergone specialist review. Seventy-six patients were included from the March-April 2020 cohort, with 77 from November 2019-January 2020 for comparison. An ID or respiratory specialist reviewed 35 patients from the March-April cohort within 24 h of admission. There was a higher rate of appropriate escalation, de-escalation, and continuation of antibiotics among those reviewed. Less than 20% of patients were started on antibiotics in accordance with CAP guidelines on admission, though the antibiotics initiated were frequently deemed appropriate in the clinical setting. Specialist review increases rates of appropriate antimicrobial prescribing and adherence with hospital guidelines in patients with CAP.
抗菌药物管理对于降低抗菌药物耐药性、降低成本以及至关重要的确保良好的患者护理而言必不可少。社区获得性肺炎（CAP）是一种常见病症，其症状与新冠肺炎（COVID-19）的症状有显著重叠。在爱尔兰爆发COVID-19疫情后，因呼吸道感染症状前来我院就诊的患者更常于入院后24小时内由传染病（ID）或呼吸内科专家进行评估。我们旨在评估在COVID-19大流行第一波期间，对具有CAP特征的入院患者进行频繁专科评估的服务提供变化如何影响抗菌药物管理和处方实践。纳入了2020年3月至4月期间由普通内科团队收治并接受CAP治疗的患者。收集了包括人口统计学、CURB-65评分和抗菌治疗在内的回顾性数据，以及患者是否接受过ID或呼吸内科医生专科评估的信息。将这些数据与2019年11月至2020年1月期间接受CAP治疗的类似队列进行比较，不过在这个队列中，在COVID-19时代之前，没有患者接受过专科评估。2020年3月至4月队列纳入了76例患者，2019年11月至2020年1月队列纳入了77例患者用于比较。在24小时内，ID或呼吸内科专家对2020年3月至4月队列中的35例患者进行了评估。在接受评估的患者中，抗生素适当升级、降级和持续使用的比例更高。入院时按照CAP指南开始使用抗生素的患者不到20%，不过在临床环境中启动的抗生素通常被认为是适当的。专科评估提高了CAP患者适当抗菌药物处方率和对医院指南的依从性。
