Community-acquired Pneumonia
Conditions
Keywords
pneumonia, antibiotic treatment, duration, clinical stability, adherence
Brief summary
International and national clinical guidelines recommend short antibiotic regimens in patients with non-severe community-acquired pneumonia (CAP) who have reached clinical stability. However, adherence to these recommendations remains unclear. The goals of this quasi-experimental trial are: 1) to assess adherence to clinical guidelines in relation to the duration of antibiotic treatment in patients hospitalized for non-severe CAP who have reached clinical stability; 2) increase adherence to clinical guidelines and reduce the use of antibiotics in patients hospitalized for non-severe CAP who have achieved clinical stability after at least 5 days of antibiotic treatment. To this end, a multicenter prospective study will be carried out over 2 years and divided into 2 phases: i) during the first year (observational phase), patients with CAP hospitalized in the participating centers will be recorded to assess objective 1; ii) to achieve objective 2, at the beginning of the second year (quasi-experimental trial) the centers will be randomized into 2 groups of hospitals, one of them a control group and the other an intervention group. The intervention will consist in automatic reminders through pop-up windows in the computerized prescription software, reminding the clinician responsible for each patient of the need to adhere to clinical guidelines regarding the duration of antibiotic treatment in patients with clinical stability.
Interventions
BEHAVIORALReminders to the assistant clinicians of the need to adhere to clinical guidelines regarding the duration of antibiotic treatment community-acquired pneumonia
Automatic reminders through pop-up windows in the computerized prescription software, reminding the clinician responsible for each patient of the need to adhere to clinical guidelines regarding the duration of antibiotic treatment in patients with clinical stability
Sponsors
Instituto de Salud Carlos III
Sociedad Española de Neumología y Cirugía Torácica
Sociedad Valenciana de Neumología
Instituto de Investigacion Sanitaria La Fe
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Patients \>18 years hospitalized for community-acquired pneumonia with a new infiltrate on chest X-ray and/or computerized tomography. * At least one compatible sign or symptom (fever, cough, expectoration, dyspnea, chest pain or crackles on auscultation) * Correctly treated with ≥ 3 days of antibiotic
Exclusion criteria
* Intensive care unit admission during the first 5 days since hospital admission * Abscess or necrotizing pneumonia * Empyema or pleural effusion requiring drainage tube * Bronchiectasis * Cystic fibrosis * Active tuberculosis * Postobstructive pneumonia * Suspected bronchial aspiration * SARS-CoV-2 infection * Immunosuppression (congenital immunodeficiencies, HIV infection, solid organ transplantation, functional or anatomical asplenia, immunosuppressive treatment, active solid or haematological neoplasia \[active treatment in the last 12 months\], etc.) * Hospital acquired pneumonia * Concomitant extrapulmonary infection that requires antibiotic treatment for more than 5 days (eg myocarditis) * Confirmed diagnosis alternative to pneumonia (eg, lung cancer)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of antibiotic treatment | 90 days | Total duration in days of antibiotic treatment (including the days of outpatient antibiotic prescribed at discharge). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of hospital stay | 90 days | Length of hospital stay in days |
| Adverse events related to antibiotic treatment | 90 days | Percentage of patients with adverse events related to antibiotic treatment |
| Patients admitted to the ICU after the 5th day | 90 days | Percentage of patients admitted to the ICU after the 5th day of admission |
| Mortality | 90 days | Percentage of patients who died during the study |
| Reintroduction of antibiotic treatment | 90 days | Percentage of patients with reintroduction of antibiotic treatment |
| Duration of antibiotic treatment after reaching clinical stability | 90 days | Duration in days of antibiotic treatment after reaching clinical stability |
| Patients treated with an adequate duration of 5±1 days | 90 days | Percentage of patients treated with an adequate duration of 5±1 days |
| Readmission | 90 days | Percentage of patients who are readmitted after hospital discharge |
Other
| Measure | Time frame | Description |
|---|---|---|
| Factors related to excess of antibiotic treatment | 90 days | Factors o variables related to excess of antibiotic treatment |
Countries
Spain
Contacts
Primary ContactRaúl Méndez, MD, PhD
Outcome results
None listed