A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa

Introduction: Pharmacists in low-middle-income countries (LMIC) are few and lack antibiotic stewardship (AS) training. The ability was assessed of non-specialised pharmacists to implement stewardship interventions and improve adherence to the South African community-acquired pneumonia (CAP) guideline in public and private hospitals. Methods: This was a multicentre, prospective cohort study of adult CAP patients hospitalised between July 2017 and July 2018. A CAP bundle was developed of seven process measures (diagnostic and AS) that pharmacists used to audit compliance and provide feedback. CAP bundle compliance rates and change in outcome measures [mortality, length of stay (LOS) and infection-related (IR)-LOS] during pre- and postimplementation periods were compared. Results: In total, 2464 patients in 39 hospitals were included in the final analysis. Post-implementation, overall CAP bundle compliance improved from 47.8% to 53.6% (confidence interval [CI] 4.1-7.5, p<0.0 001), diagnostic stewardship compliance improved from 49.1% to 54.6% (CI 3.3-7.7, p<0.0 001) and compliance with AS process measures from 45.3% to 51.6% (CI 4.0-8.6, p<0.0001). Improved compliance with process measures was significant for five (2 diagnostic, 3 AS) of seven components: radiology, laboratory, antibiotic choice, duration and intravenous to oral switch. There was no difference in mortality between the two phases, [4.4%(55/1247) vs. 3.9%(47/1217); p=0.54], median LOS or IR LOS 6.0 vs. 6.0 days (p=0 .20) and 5.0 vs. 5.0 days (p=0.40). Conclusion: Non-specialised pharmacists in public and private hospitals implemented stewardship interventions and improved compliance to SA CAP guidelines. The methodology of upskilling and a shared learning stewardship model may benefit LMIC countries. (C) 2020 The Authors. Published by Elsevier Ltd.