Help Reduce Community-Acquired Pneumonia Hospitalizations: Observing World Pneumonia Day
By Alex Fernandez
This World Pneumonia Day, learn how you can answer the call for antibiotic stewardship to curb a leading cause of hospitalizations in the U.S.
In 2019, pneumonia claimed the lives of 2.5 million adults and children worldwide. In the U.S. alone, the estimated burden of community-acquired pneumonia (CAP) includes more than 1.5 million adults hospitalized annually, with 100,000 deaths occurring during hospitalization and approximately one-third of those hospitalized patients dying within one year. Statistics prior to 2020 indicate that pneumonia is among the most deadly infectious diseases affecting adults and children. Now, the COVID-19 pandemic and related pneumonia cases have spread rapidly around the world.
The global pandemic has led to a dramatic spike in pneumonia hospitalizations and deaths. According to COVID-19 mortality data from the Centers for Disease Control and Prevention (CDC), influenza and pneumonia are the most frequently listed comorbid conditions (339,190 deaths) in patients with COVID-19. In addition to this, the CDC reports that 95% of all death certificates for COVID-19 deaths list co-morbidities or other conditions.
Despite the predominance of pneumonia cases in the U.S., there is a staggering lack of awareness of the virus amongst at-risk patients. A study from the National Foundation for Infectious Disease (NFID) found that 46% of individuals at higher risk of pneumococcal disease were unfamiliar with pneumonia, and 60% of higher-risk individuals reported that they had never been advised to get vaccinated against pneumococcal disease. In order to combat pneumonia and the lack of awareness that surrounds it, nurse practitioners (NPs) must take up the call for antibiotic stewardship in their practices to better protect their patients.
Studying the Latest Guidelines for CAP
Thankfully, tools and resources for the diagnosis and treatment of pneumonia have been released in recent years. The latest recommended guidelines for CAP were approved and published by the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS) in 2019. While these guidelines do retain some recommendations from the previous iterations, they address 16 specific areas for recommendations — spanning questions of diagnostic testing, determination of site of care, selection of initial antibiotic therapy and management decisions that incorporate information from the results of new therapeutic trials and epidemiological investigations.
Guidelines like these are an invaluable resource for combatting CAP misinformation, lack of awareness and improper treatment. The scope and schema of health care are constantly changing, due to advances in evidence-based practice, emerging treatments and technologies and evolving health care challenges. In this regard, NPs are encouraged to review the latest CAP guidelines to better aid their patients and to continue demonstrating excellence among their peers in the health care field.
Answering the Call for Antibiotic Stewardship
When it comes to pneumonia treatment, many of the same antibiotic treatments that have been used for decades still prove more than adequate at eliminating the illness. While news of an existing and effective treatment for CAP is a relief, the effectiveness of this treatment is dependent on the appropriate use of antibiotics across the board. The CDC has identified antibiotic resistance as one of the biggest public health threats in the U.S and reports that at least 50% of antibiotic prescriptions for acute respiratory infections across all age groups were unnecessary.
Back in 2015, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the U.S. — enough for five out of every six people in the country to receive one antibiotic prescription that year. In this regard, engaging patients is critical to the effort to improve the use of antibiotics. Helping patients know what they can do to keep themselves and their loved ones safe helps build a foundation against antibiotic misuse and resistance.
Even when antibiotics are truly needed for CAP or urinary tract infections, a study from the CDC and Pew Charitable Trusts revealed that over half the patients were prescribed an antibiotic not recommended by current clinical guidelines. Even in cases where antibiotics are the proper treatment solution, there are still issues regarding the drug selection, dosage and duration of prescribed antibiotics.
The CDC defines antibiotic stewardship as the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use and combat antibiotic resistance. Antibiotic stewardship is imperative in the ongoing struggle against CAP, and NPs should seek to become antibiotic stewards in their place of practice to help reduce the spread of CAP in their community.
Opportunities for Primary Care and Emergency NPs to Reduce Hospitalizations
It’s time to expand your knowledge. Primary Care and Emergency NPs, as well as those practicing in urgent care and retail clinic settings, are ideally positioned to impact patients at risk of contracting pneumonia and patients with pneumonia who are at risk of hospitalization. Visit the AANP CE Center to enroll in a free activity that will update NPs on current guidelines for preventing, treating, and managing community-acquired bacterial pneumonia (CABP) in both the primary care and emergency care settings.
Enroll in Reducing Hospitalizations: CABP Management Updates for Primary Care with NPs Drs. Wendy Wright and Michael Gooch and earn 2.5 contact hours of continuing education (CE) credit. If you want to learn more about pneumonia, then join Drs. Gooch and Wright on the go as they discuss CABP on an episode of AANP’s official podcast, NP Pulse: The Voice of the Nurse Practitioner®.