1030. Broad-spectrum antibiotics offer no advantage over guideline-recommended antibiotics for patients with severe community-acquired pneumonia (CAP)
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Background:

Patients with severe CAP may unnecessarily receive broad-spectrum antibiotics despite limited supporting literature. The objective of this study was to evaluate outcomes of patients with severe CAP treated with broad-spectrum antibiotic regimens versus IDSA guideline-recommended regimens.

Methods:

This was a retrospective, case-control study. Patients were identified using criteria of the CMS Pneumonia Core Measure Initial Antibiotic Selection for CAP in Immunocompetent Patients ICU. Patients were excluded if they lacked radiographic evidence of pneumonia or any sign of infection. Cases received broad-spectrum therapy (e.g. piperacillin/tazobactam) and controls received IDSA guideline-recommended therapy (ceftriaxone-based regimens). Cases and controls were matched based on severity of illness using APACHE II score. The primary outcome was 30-day mortality. Secondary outcomes included days of therapy (DOT), hospital length of stay (LOS), readmission within 30 days, Clostridium difficile infection, acute kidney injury (RIFLE criteria), and Candida superinfection.

Results:

62 patients were enrolled; 31 cases and 31 controls. The mean age in both groups was 61 years, 45% were male, and 68% were white. The mean APACHE II score in both groups was 21. 30-day mortality was 16.1% among cases and 6.4% among controls (p=0.43). Results of secondary outcomes are listed in the table.

 

Outcome

Cases

Controls

p-value

Intravenous DOT, median (range)

9 (2-52)

5 (1-22)

0.01

Total DOT, median (range)

9 (3-52)

7 (2-27)

0.02

Ventilated days, median (range)

7 (1-59)

5 (1-18)

0.26

ICU LOS, median (range)

4.5 (1-69)

3 (1-26)

0.03

Total LOS, median (range)

9.5 (2-69)

6.5 (2-29)

0.05

Readmission within 30 days, n (%)

6 (23.1)

4 (13.3)

0.49

C. difficile infection, n

2

0

1.00

Candida superinfection, n

5

1

0.20

Acute kidney injury, n (%)

8 (25.8)

4 (12.9)

0.34

Conclusion:

Broad-spectrum therapy conferred no clinical benefit in patients with severe CAP. Patients with CAP should be treated with IDSA guideline-recommended antibiotics, regardless of disease severity.

 

Kate Kupiec, PharmD1, James Johnson, PharmD1, Christopher Ohl, MD2, James Beardsley, PharmD1, Vera Luther, MD2 and John Williamson, PharmD1, (1)Wake Forest Baptist Health, Winston-Salem, NC, (2)IM-Section On Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC

Disclosures:

K. Kupiec, None

J. Johnson, None

C. Ohl, None

J. Beardsley, None

V. Luther, None

J. Williamson, None

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