Cost and clinical analysis of community-acquired pneumonia within an antimicrobial stewardship-governed academic hospital in South Africa, and its implications

BACKGROUND: Pneumonia is a common respiratory infection treated with antibiotics. Patients needing antibiotics risk poor outcomes due to antimicrobial resistance (AMR). In LMIC, inappropriate prescribing is common due to a lack of sufficient diagnostics, leading to empiric prescribing. Antimicrobial stewardship programmes can improve prescribing practices. RESEARCH DESIGN AND METHODS: A retrospective cohort study reviewing antibiotic prescription charts from May to September 2024 at an academic hospital in South Africa. A treatment pathway model was used to evaluate patients' clinical outcomes. RESULTS: Severe pneumonia was observed in 59.3% of patients, compared with 40.7% with uncomplicated pneumonia, with the majority of severe cases occurring in patients aged 51-75 years (37.5%). The cost of treatment per patient was higher for severe pneumonia (R1,328.12) versus uncomplicated cases (R1,157.40), with labor costs the largest cost component (58%). Severe cases contributed 63% (R63, 749.10) of total treatment costs, while uncomplicated cases accounted for 37% (R38,195.50). The treatment pathway model analysis indicated that hospitalisation rates decreased from 85% on Review Day 3 to 58% on Review Day 7 for severe cases. CONCLUSION: Higher treatment costs and longer hospital stays were associated with severe pneumonia, underscoring the need for early, appropriate intervention.