Epidemiology and Appropriateness of Antibiotic Prescribing in Severe Pneumonia after Lung Resection.

BACKGROUND: Post-operative pneumonia (POP) is a severe complication of major lung resection. Our objective was to describe the current epidemiology and appropriateness of antibiotic prescriptions in severe POP, four years after implementation of an antimicrobial stewardship program based on weekly multidisciplinary review of all antibiotic therapies.

METHODS: Retrospective analysis of a prospectively collected database. We included all cases of severe POP occurring within 30 days after major lung resection of our 1500-bed hospital between 2013 and 2015. Criteria for severe POP were: acute respiratory failure, severe sepsis or rapidly extensive pulmonary infiltrate. We collected data on incidence, clinical outcomes and microbiological analyses. Appropriateness of antibiotic prescribing was assessed by quality indicators previously validated in the literature.

RESULTS: Over the study period, 1555 patients underwent major lung surgery. Severe POP occurred in 91 patients (5.8%, confidence interval, CI: 4.7% ; 7.0%),with mortality rate of 9.0% (8/91, CI: 3.0% ; 14.6%). In POP with positive microbiological analyses, the proportion of gram-negative bacteria other than Haemophilus was of 76% (50/66). All patients (91/91) had respiratory samples taken within 24h after the start of antibiotics, empirical therapy was concordant with the guideline in 80% (69/86), and switched to pathogen-directed therapy in in 74% (46/62). In 71/91 patients (78%), antibiotic duration was ≤7 days.

CONCLUSIONS: We report a high proportion of gram-negative bacteria in severe POP. Four years after implementation of the program, quality indicators of antibiotic prescribing were all >70%. Rate of de-escalation to pathogen-directed therapy could however be improved.