Dataset Information

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study.

ABSTRACT:

Objective

We aimed to assess prescribing practices, compliance with guidelines, and outcomes for patients who were admitted to the authors' institution with community-acquired pneumonia (CAP).

Methods

We performed a single-center retrospective cross-sectional study of adults with CAP presenting during the 2019 influenza season. CAP severity was assessed using the CURB-65 risk score. The effect of CURB-65 risk score use on the rate of appropriate antimicrobial prescribing was assessed using the chi-square test and reported as odds ratio (OR). Fisher's exact test was used to assess the relationship between prescribing appropriateness and patient outcomes.

Results

Patients with low-risk CAP were most likely to be inappropriately prescribed antimicrobials (OR: 4.77; 95% confidence interval: 2.44-10.47). In low-risk CAP, the most common prescribing error was overuse of ceftriaxone. In high-risk CAP, the most common errors were ceftriaxone underdosing and missed atypical coverage with azithromycin. Overall, 80% of patients were considered to have been inappropriately prescribed antimicrobials. No effect on mortality was observed.

Conclusions

In this study, we found low use of CAP risk scores and low adherence to antimicrobial prescribing guidelines for CAP at the authors' institution.

SUBMITTER: Robert L

PROVIDER: S-EPMC8647258 | biostudies-literature | 2021 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study.

Robert Lawless L Mark Vickers V Moayed Alawami A Nivashen Appasamy A Vinod Rajasingam R Sophie Paviour P Mohamed El Washahy EW Rusheng Chew C

The Journal of international medical research 20211101 11

<h4>Objective</h4>We aimed to assess prescribing practices, compliance with guidelines, and outcomes for patients who were admitted to the authors' institution with community-acquired pneumonia (CAP).<h4>Methods</h4>We performed a single-center retrospective cross-sectional study of adults with CAP presenting during the 2019 influenza season. CAP severity was assessed using the CURB-65 risk score. The effect of CURB-65 risk score use on the rate of appropriate antimicrobial prescribing was asses ...[more]

PMID: 34826375

Similar Datasets

Project description:BackgroundCommunity-acquired pneumonia (CAP) is an acute respiratory infection with a high clinical and economic burden. Clarifying the burden is important for health policy making. However, there is inadequate data on the economic burden of childhood CAP in China. In this study, the direct disease burden of CAP in children was analyzed using city-level data.MethodsA cross-sectional study of the direct costs of CAP for hospitalized children aged 28 days to 18 years old in Shanghai from January 2018 to December 2020 was performed. Information, including the hospitalization costs from the first page of the children's hospitalized medical records, was obtained. The direct costs included medical services, diagnostics, medications, and medical supplies. The continuous variables with non-normal distributions are expressed as the median (interquartile range). Comparisons between groups were performed using the Kruskal-Wallis H test. The enumeration data are expressed as the number (percentage), and comparisons between groups were performed using the χ2 test.ResultsA total of 59 hospitals and 63,614 hospitalized CAP patients were included in this study. Significantly fewer patients were discharged in 2020 than 2018 and 2019 (6,662, 27,943, and 29,009, respectively, P<0.001). Among the patients, 27,741 patients (43.6%) were covered by social medical insurance, 13,509 (21.2%) by commercial health insurance, and 22,364 (35.2%) were self-paying. The annual total direct costs for 2018, 2019, and 2020 were 118.553, 140.865, and 40.064 million Chinese Yuan (CNY), respectively. The average direct costs per hospital stay due to pediatric CAP in Shanghai was 4,707.83 CNY in 2018, a sum that accounted for 7.3% and 16.7% of the per capita disposable income in Shanghai and China in 2018, respectively. The total costs of the group aged <1 year were significantly higher than those of the other age groups (6,271.1 vs. 3,244.3~4,610.7 CNY, P<0.001). The total costs of severe cases were significantly higher than those of non-severe cases (5,200.6 vs. 3,170.4 CNY, P<0.001). The median duration of hospital stay was 6.0 days (5.0, 8.0).ConclusionsCAP hospitalization continues to represent a high clinical and economic burden in Shanghai, China. Specialized hospitals, severe cases, and the length of hospital stay were positively correlated with inpatient costs.

Project description:ImportancePatients with alcohol use disorder (AUD) are at elevated risk of developing pneumonia, but few studies have assessed the outcomes of pneumonia in patients with AUD.ObjectivesTo compare the causes, treatment, and outcomes of pneumonia in patients with and without AUD and to understand the associations of comorbid illnesses, alcohol withdrawal, and any residual effects due to alcohol itself with patient outcomes.Design, setting, and participantsA retrospective cohort study was conducted of 137 496 patients 18 years or older with pneumonia who were admitted to 177 US hospitals participating in the Premier Healthcare Database from July 1, 2010, to June 30, 2015. Statistical analysis was conducted from October 27, 2017, to August 20, 2018.ExposureAlcohol use disorders identified from International Classification of Diseases, Ninth Revision, Clinical Modification codes.Main outcomes and measuresPneumonia cause, antibiotic treatment, inpatient mortality, clinical deterioration, length of stay, and cost. Associations of AUD with these variables were studied using generalized linear mixed models.ResultsOf 137 496 patients with community-acquired pneumonia (70 358 women and 67 138 men; mean [SD] age, 69.5 [16.2] years), 3.5% had an AUD. Patients with an AUD were younger than those without an AUD (median age, 58.0 vs 73.0 years; P < .001), more often male (77.3% vs 47.8%; P < .001), and more often had principal diagnoses of aspiration pneumonia (10.9% vs 9.8%; P < .001), sepsis (38.6% vs 30.7%; P < .001), or respiratory failure (9.3% vs 5.5%; P < .001). Their cultures more often grew Streptococcus pneumoniae (43.7% vs 25.5%; P < .001) and less frequently grew organisms resistant to guideline-recommended antibiotics (25.0% vs 43.7%; P < .001). Patients with an AUD were treated more often with piperacillin-tazobactam (26.2% vs 22.5%; P < .001) but equally as often with anti-methicillin-resistant Staphylococcus aureus agents (32.9% vs 31.8%; P = .11) compared with patients without AUDs. When adjusted for demographic characteristics and insurance, AUD was associated with higher mortality (odds ratio, 1.40; 95% CI, 1.25-1.56), length of stay (risk-adjusted geometric mean ratio, 1.24; 95% CI, 1.20-1.27), and costs (risk-adjusted geometric mean ratio, 1.33; 95% CI, 1.28-1.38). After additional adjustment for differences in comorbidities and risk factors for resistant organisms, AUD was no longer associated with mortality but remained associated with late mechanical ventilation (odds ratio, 1.28; 95% CI, 1.12-1.46), length of stay (risk-adjusted geometric mean ratio, 1.04; 95% CI, 1.01-1.06), and costs (risk-adjusted geometric mean ratio, 1.06; 95% CI, 1.03-1.09). Models segregating patients undergoing alcohol withdrawal showed that poorer outcomes among patients with AUD were confined to the subgroup undergoing alcohol withdrawal.Conclusions and relevanceThis study suggests that, compared with hospitalized patients with community-acquired pneumonia but without AUD, those with AUD less often harbor resistant organisms. The higher age-adjusted risk of death among patients with AUD appears to be largely attributable to differences in comorbidities, whereas greater use of health care resources may be attributable to alcohol withdrawal.

Dataset Information

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study.

Objective

Methods

Results

Conclusions

Publications

Antimicrobial prescribing and outcomes of community-acquired pneumonia in Australian hospitalized patients: a cross-sectional study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets