Faculty Collaboration Database

A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia. J Antimicrob Chemother 2018 May 01;73(5):1402-1407

Date

02/21/2018

Pubmed ID

29462306

DOI

10.1093/jac/dky021

Scopus ID

2-s2.0-85047020330 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

BACKGROUND: The increased emphasis on pneumonia-related performance measures and patient outcomes has led hospitals to implement multifaceted approaches to quickly identify patients with community-acquired pneumonia (CAP), start timely therapy and reduce readmission. However, there has been minimal focus on duration of therapy (DOT) and patients often receive prolonged antibiotic courses. The IDSA and American Thoracic Society (IDSA/ATS) CAP guidelines recommend 5 days of therapy for clinically stable patients that quickly defervesce and stewardship teams are well positioned to influence prescribing practices.

OBJECTIVES: Determine the impact of a prospective stewardship intervention on total antibiotic DOT and associated clinical outcomes in hospitalized patients with CAP.

METHODS: This multicentre, quasi-experimental study evaluated three concurrent interventions over a 6 month period to promote appropriate DOT. All centres updated institutional CAP guidelines to promote IDSA/ATS-concordant DOT, provided education and conducted daily audit and feedback with intervention to provide patient-specific DOT recommendations.

RESULTS: A total of 600 patients with CAP were included (307 in the historical control group and 293 in the stewardship intervention group). The stewardship intervention increased compliance with DOT recommendations (42% versus 5.6%, P < 0.001) and reduced the median DOT per patient (6 versus 9 days, P < 0.001). Clinical outcomes, including mortality, readmission with pneumonia, presentation to the emergency centre/clinic with pneumonia and incidence of Clostridium difficile infection within 30 days of discharge, were not different between groups.

CONCLUSIONS: This multicentre evaluation of a stewardship intervention in hospitalized CAP patients reduced the total antibiotic DOT and increased guideline-concordant DOT without adversely affecting patient outcomes.

Author List

Foolad F, Huang AM, Nguyen CT, Colyer L, Lim M, Grieger J, Li J, Revolinski S, Mack M, Gandhi T, Wainaina JN, Eschenauer G, Patel TS, Marshall VD, Nagel J

Authors

Sara L. Revolinski PharmD Adjunct Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin
Jane N. Wainaina MD Vice Chair, Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Antimicrobial Stewardship
Clostridium Infections
Community-Acquired Infections
Drug Utilization
Emergency Medical Services
Female
Health Services Research
Humans
Male
Middle Aged
Non-Randomized Controlled Trials as Topic
Patient Readmission
Pneumonia
Survival Analysis
Time
Young Adult