1048. Antibiotic Use in Patients Hospitalized for Community-acquired Pneumonia (CAP)
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster_Zeeshan_IDSA_092413_final.pdf (210.3 kB)
  • Background: Better antibiotic stewardship is needed in the management of patients admitted for a Syndrome consistent with CAP. In this observational study we evaluated antimicrobial therapy in patients admitted for CAP in whom diagnoses were refined by systematic application of the best available diagnostic techniques.

    Methods: All patients admitted with findings consistent with CAP were included. In addition to history, physical examination and basic laboratory and radiologic studies, sputum and blood cultures, urine tests for pneumococcal and Legionella antigens, nasopharyngeal swab for viral PCR, B-natriuretic protein and serum procalcitonin were obtained in nearly every case.  Clinical and laboratory criteria were used to stratify patients to the following categories:  proven bacterial (bacteria isolated from a normally sterile site); presumptive bacterial (pathogenic bacteria isolated from sputum); fungal (PCP); viral (+PCR without evidence for bacterial coinfection); uninfected (clear evidence for a non-infectious cause such as pulmonary edema, lung cancer or pulmonary fibrosis and no evidence for infection); post-obstructive (distal to a lung cancer); and unknown, which were further stratified into likely bacterial, likely nonbacterial and true unknown.

    Results: We studied numbers of antibiotics given and duration of each, reported as CDU (total days of all antibiotics given for the pneumonia).

     Stratification

    No of Patients

    Total No of antibiotics [Inpatient + Outpatient] (Mean)

     

    CDU (Total days of all antibiotics) (Mean)

     

    Bacterial presumptive

    32

    2.8

    17.8

    Bacterial proven

    28

    3.3

    19.6

    Viral

    20

    2.1

    13

    Fungal

    6

    3.2

    30

    Uninfected

    21

    2.5

    11.1

    Unknown true

    32

    2.6

    14.9

    Unknown Non-bacterial

    18

    2.9

    18.1

    Unknown Bacterial

    84

    3.1

    17.2

    Post obstructive

    18

    2.3

    14.9

    Conclusion: Despite obvious differences in clinical syndromes and diagnoses, the number and duration of antibiotics was not that dissimilar.

    Daniel Musher, MD, FIDSA1,2, Zeeshan Afzal, MD2, Nancy Logan1,2 and Charles Stager, PhD1,2, (1)Baylor College of Medicine, Houston, TX, (2)Michael E. Debakey VA Medical Center, Houston, TX

    Disclosures:

    D. Musher, None

    Z. Afzal, None

    N. Logan, None

    C. Stager, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.