Microbiological Findings and Antibiotic Treatment of Pneumonia: a single-centre retrospective descriptive study
Author
Shanmuganathan, Sabisan
Term
5. Term (Master thesis)
Education
Publication year
2023
Submitted on
2023-01-05
Pages
22
Abstract
Baggrund: Nationale og regionale retningslinjer skal sikre korrekt diagnosticering og behandling af lungebetændelse og samtidig begrænse unødvendig brug af antibiotika. Nye studier har rejst tvivl om anbefalingerne i de danske retningslinjer. Vi undersøgte årsager til lungebetændelse, valg af antibiotika og om den initiale (empiriske) behandling fulgte retningslinjerne hos voksne indlagt med lungebetændelse. Metode: Retrospektiv, beskrivende undersøgelse af alle voksne indlagt på Akutmodtagelsen, Aalborg Universitetshospital, Danmark, fra november 2021 til juni 2022. Primært COVID-19-indlagte blev udelukket. Journaler blev gennemgået; mikrobiologiske fund og antibiotikabehandling blev analyseret. Resultater: 306 patienter, medianalder 77 år. 42% havde KOL, 16% var nyligt (≤28 dage) indlagt, og 8% var immunsvækkede. 73% havde CURB-65 <2; CURB-65 er et standard alvorlighedsscore for lungebetændelse, hvor højere score angiver mere alvorlig sygdom. 97% fik mindst én mikrobiologisk test, og 26% havde positive fund. Det hyppigste patogen var influenza A (22%). Blandt bakterier var Haemophilus influenzae (16%) hyppigst, efterfulgt af Staphylococcus aureus (10%). H. influenzae var hyppigste bakteriefund både hos patienter med og uden KOL. S. aureus blev oftest påvist hos patienter med CURB-65 3-5 (23%). I den empiriske antibiotikabehandling (startet før prøvesvar) fik 40% af immunkompetente patienter med samfundserhvervet lungebetændelse (CAP) ikke behandling i overensstemmelse med de regionale retningslinjer, primært pga. overbehandling med bredspektrede antibiotika. Ved indlæggelse blev oftest ordineret amoxicillin/clavulansyre (32%), piperacillin/tazobactam som monoterapi (21%) og penicillin som monoterapi (18%). Den mediane behandlingsvarighed var 8 dage. Konklusion: H. influenzae var det dominerende bakteriefund hos både patienter med og uden KOL. Amoxicillin/clavulansyre var det hyppigst ordinerede antibiotikum ved indlæggelse. 40% af immunkompetente CAP-patienter fik empirisk behandling, der ikke fulgte de regionale retningslinjer, primært pga. brug af bredspektrede antibiotika.
Background: National and regional guidelines aim to ensure accurate diagnosis and treatment of pneumonia while limiting unnecessary antibiotic use. Recent studies have questioned some recommendations in Danish guidelines. We examined the causes of pneumonia, antibiotic choices, and adherence to guidelines in the initial (empirical) management of adults hospitalized with pneumonia. Methods: Retrospective descriptive study of all adults hospitalized at the Emergency Department of Aalborg University Hospital, Denmark, from November 2021 to June 2022. Patients primarily admitted for COVID-19 were excluded. Hospital records were reviewed; microbiology results and antibiotic therapy were analyzed. Results: 306 patients, median age 77 years. Overall, 42% had COPD, 16% had been hospitalized within the previous 28 days, and 8% were immunocompromised. Most had a CURB-65 score below 2 (73%); CURB-65 is a standard pneumonia severity score, where higher scores indicate more severe illness. In total, 97% had at least one microbiological test, and 26% had positive findings. The most frequently identified pathogen was influenza A (22%). Among bacteria, Haemophilus influenzae (16%) was most common, followed by Staphylococcus aureus (10%). H. influenzae was the leading bacterial finding in both COPD and non-COPD patients. S. aureus was most frequently detected in patients with a CURB-65 score of 3-5 (23%). Regarding empirical antibiotics (started before test results), 40% of immunocompetent patients with community-acquired pneumonia (CAP) did not receive treatment consistent with regional guidelines, mainly due to overtreatment with broad-spectrum antibiotics. On admission, the most commonly prescribed empirical antibiotics were amoxicillin/clavulanic acid (32%), piperacillin/tazobactam monotherapy (21%), and penicillin monotherapy (18%). The median length of antibiotic treatment was 8 days. Conclusion: H. influenzae was the dominant bacterial finding among both COPD and non-COPD patients with pneumonia. Amoxicillin/clavulanic acid was the most frequently started antibiotic on admission. Overall, 40% of immunocompetent CAP patients received empirical therapy not in line with regional guidelines, mainly due to unnecessary use of broad-spectrum antibiotics.
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