Development And Evaluation Of An Antimicrobial Stewardship–Guided Nursing Care Model For Severe Pneumonia: A Retrospective Cohort Study

BACKGROUND: Severe pneumonia is associated with high mortality and substantial antimicrobial exposure. Inappropriate antimicrobial use contributes to antimicrobial resistance and adverse drug reactions, potentially worsening outcomes. OBJECTIVES: To develop and evaluate an antimicrobial stewardship-guided nursing care model for patients with severe pneumonia. METHODS: A single-center retrospective cohort study was conducted at the Second Medical Center of Chinese People's Liberation Army General Hospital (Beijing, China). Medical records of patients with severe pneumonia admitted between June 2024 and June 2025 were reviewed. Patients admitted in June-December 2024 received routine nursing care, whereas those admitted in January-June 2025 received a stewardship-guided nursing model. Outcomes were assessed until discharge or day 28, whichever occurred first. RESULTS: Compared with routine care, the stewardship-guided cohort showed higher specimen collection compliance and antimicrobial selection rationality scores and lower drug utilization index (DUI), defined daily doses (DDDs) and inappropriate use of core antimicrobials (all p<0.05). Clinical cure rate was higher, length of stay and inflammatory-marker recovery time were shorter and complication rates were lower (all p<0.05). Nursing quality and patient satisfaction scores also improved (p<0.001). CONCLUSION: An antimicrobial stewardship-guided nursing care model was associated with improved antimicrobial-use quality, reduced antimicrobial-related complications and better clinical and nursing outcomes in patients with severe pneumonia; however, causal inference is limited by the non-concurrent retrospective design.