• J. Antimicrob. Chemother. · May 2018

    Multicenter Study

    A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia.

    • Farnaz Foolad, Angela M Huang, Cynthia T Nguyen, Lindsay Colyer, Megan Lim, Jessica Grieger, Julius Li, Sara Revolinski, Megan Mack, Tejal Gandhi, J Njeri Wainaina, Gregory Eschenauer, Twisha S Patel, Vincent D Marshall, and Jerod Nagel.
    • Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
    • J. Antimicrob. Chemother. 2018 May 1; 73 (5): 1402-1407.

    BackgroundThe 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.ObjectivesDetermine the impact of a prospective stewardship intervention on total antibiotic DOT and associated clinical outcomes in hospitalized patients with CAP.MethodsThis 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.ResultsA 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.ConclusionsThis 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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