Farnaz Foolad1, Angela M Huang2, Cynthia T Nguyen3, Lindsay Colyer4,5, Megan Lim4,5, Jessica Grieger6, Julius Li7, Sara Revolinski2,8, Megan Mack9, Tejal Gandhi10, J Njeri Wainaina11, Gregory Eschenauer4,5, Twisha S Patel4,5, Vincent D Marshall4,5, Jerod Nagel4,5. 1. Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 2. Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA. 3. Department of Pharmacy, University of Chicago Medicine, Chicago, IL, USA. 4. Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, USA. 5. College of Pharmacy, University of Michigan, Ann Arbor, MI, USA. 6. Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA. 7. Department of Pharmacy, Ochsner Medical Center, New Orleans, LA, USA. 8. Medical College of Wisconsin School of Pharmacy, Milwaukee, WI, USA. 9. Division of Hospital Medicine, Michigan Medicine, Ann Arbor, MI, USA. 10. Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI, USA. 11. Section of Perioperative Medicine and Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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.
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.
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