4CPS-011 Antimicrobial stewardship recommendations in patients with respiratory tract infections in an intermediate care hospital

<h3>Background and Importance</h3> Antimicrobial Stewardship Programmes (ASP) aim to optimise antimicrobial use to minimise unnecessary exposure and adverse outcomes. Respiratory tract infections are highly prevalent and are associated with high morbidity and mortality rates. <h3>Aim and Objectives</h3> - Define patient profile with respiratory tract infections (RTIs) admitted to an Intermediate Care Hospital (ICH). -Examine common etiological agents and prescribed antimicrobial treatments. -Assess the ASP team recommendations and their acceptance by prescribers. <h3>Material and Methods</h3> We conducted an observational, retrospective study of patients admitted to a 116-bed ICH from September 2022 to February 2024, with RTI reviewed by the ASP team. <h3>Variables included</h3> age, gender, infection type (pneumonia (P) or lower respiratory tract infection (LRTI)), microbiological tests performed, prescribed antibiotics, empirical or targeted treatment, adherence to clinical guidelines, ASP recommendation and acceptance. Quantitative variables were expressed with median and interquartile range, and qualitative variables with number and percentage. <h3>Results</h3> 273 treatments were reviewed. 74% were LRTI and 26% were P. The median age was 87 years [80–90], with 52% females. Microbiological tests were performed in 48% (n=130): antigenuria (n=80), sputum (n=52), and blood cultures (n=43). Antigenuria was positive in 11 patients (14%), all due to <i>Streptococcus pneumoniae</i>. Sputum cultures were positive in 35 patients (67%). Identifying <i>Pseudomonas aeruginosa</i> (n=14) most frequently, followed by <i>Staphylococcus aureus</i> (n=6, 3 methicillin-resistant) and <i>Escherichia coli</i> (n=4, 2 extended-spectrum beta-lactamase(ESBL) producers). 1 blood culture (2%) was positive for an ESBL producer <i>Klebsiella pneumoniae</i>. 89% of treatments were empirical, 81% following guidelines. The most prescribed antibiotics were amoxicillin/clavulanate (31%), levofloxacin (27%), and piperacillin-tazobactam (18%). <h3>ASP team recommendations were</h3> 56% (n=153) stop antibiotic, 21% (n=56) switch to oral route, 18% (n=48) maintain treatment, 4% (n=12) reduce spectrum, 1% (n=2) increase spectrum and 1% (n=2) change in dosage. Recommendations were accepted in 82% of cases (n=118). <h3>Conclusion and Relevance</h3> Patients with RTIs were predominantly elderly with LRTIs. Sputum cultures were the most informative, with <i>Pseudomonas aeruginosa</i> being the most common isolate. Most treatments were empirical, with high adherence to guidelines. The ASP team effectively optimised treatment duration, with high acceptance of its recommendations. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest