Preliminary Assessment of Adherence to CURB-65 Criteria And National Antimicrobial Guideline for the Treatment of Inpatients with Community-Acquired Pneumonia in a Tertiary Care Hospital in Kelantan, Malaysia

Abstract

Community-acquired pneumonia (CAP) is a common infection that can affect an individual at any point in life and needs to be treated accordingly. Therefore, the current study was conducted to evaluate the adherence to CURB-65 criteria and National Antimicrobial Guideline (NAG) 2019 when determining hospitalization and prescribing empirical antibiotic therapy for adult CAP patients in the inpatient setting. A retrospective, cross-sectional study was carried out from 1 October 2022 to 31 December 2022 in medical wards of Hospital Raja Perempuan Zainab II, Kelantan. Eligible subjects were identified upon hospitalization, from the ward census data using convenience sampling. Then, relevant information was obtained from the Patient Management System (SPP) and Pharmacy Information System (PhIS). Descriptive statistics were utilized using Statistical Package for the Statistical Package for the Social Sciences (SPSS) version 20.0. A total of 122 patients were recruited with the mean (SD) age was 58.2 (19.8) years old. They were predominantly female (n=92, 75.4%) of Malay ethnicity (n=118, 96.7%). A mere 52 (42.6%) admissions of CAP patients into medical wards were adherent to CURB-65 criteria while the remaining hospitalizations were not adherent (n=70, 57.4%). It was found that intravenous (IV) amoxicillin/clavulanate plus azithromycin was mostly prescribed as the empirical antibiotic therapy (n=75, 61.5%). Based on the prescribing pattern, only 62 (50.8%) CAP patients were prescribed antibiotics according to NAG 2019 whilst the rest were not adherent (n=60, 49.2%). The two types of nonadherences detected were prescribing different choices of antibiotics (n=46, 37.7%) and endorsing the durations of antibiotics other than those stated in NAG 2019 (n=14, 11.5%). The present findings revealed that the adherence to CURB-65 criteria and NAG 2019 was unsatisfactory and should be improved. Further investigation is necessary to gain further insight into the appropriate antibiotic use and antimicrobial resistance.