1051. Implementation of a Guideline for Community-Acquired Pneumonia is Associated with a Reduction in Antibiotic Class Switching and Length of Therapy
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Community-acquired pneumonia (CAP) is the most common reason for hospital admission for antibiotic treatment.  CAP can be treated with short durations (< 7 days) of relatively narrow-spectrum antibiotics.  We previously demonstrated that unnecessary resource utilization, transition to a new antibiotic class at discharge, and excessive treatment durations were common.  We developed and implemented an institutional guideline for the management of CAP and report on its impact.

Methods: The guideline was a one-page decision support algorithm developed with multi-disciplinary input.  Use of CT scan if an infiltrate was present on chest radiograph, routine sputum culture, and prescription of a new antibiotic class at discharge were discouraged.   A 5-day total duration of therapy was recommended in clinically responding cases.  The guideline was published on an internal website and publicized by peer champions at staff meetings.  We performed a retrospective review of adults admitted with CAP between 5/1/2010-5/31/2011(baseline period) and 7/1/2011-7/31/2012 (intervention period).  The primary outcomes evaluated were use of sputum culture and CT scan, antibiotic class-switching (with exposure to 3 or more drug classes, and the duration of therapy.

Results: 166 and 46 patients were included in the baseline and intervention periods, respectively.  Use of sputum culture decreased from 84 (51%) cases during the baseline period to 7(15%) during the intervention (p=0.02).  Use of chest CT decreased from 39 (50%) to 12 (26%) cases (p=0.14). Changes in antibiotic use included the following: 

 

Outcome

Baseline

Intervention

p-value

Initial therapy with B-lactam+ macrolide

147 (89%)

43 (93%)

0.40

New antibiotic class at discharge

97 (66%)

15 (35%)

0.004

Discharge therapy

 

 

 

   Macrolide

29 (17%)

22 (48%)

< 0.0001

   Fluoroquinolone

99 (60%)

15 (33%)

0.001

Median length of therapy (Interquartile range (IQR))

10 (8-14)

7 (5-8)

<0.0001

Conclusion: Implementation of a CAP guideline was associated with reductions in resource utilization, use of a new antibiotic class at discharge, and total length of therapy.  Antibiotic stewardship programs that target antibiotic use through institutional guideline implementation can have a substantial impact on prescribing practices.

Michelle Haas, MD1, Bryan Knepper, MPH, MSc1, Sarah Stella, MD1, Lilia Cervantes, MD1, Connie Price, MD1, William Burman, MD1, Philip Mehler, MD1 and Timothy Jenkins, MD1,2, (1)Denver Health Medical Center, Denver, CO, (2)University of Colorado Health Sciences Center, Denver, CO

Disclosures:

M. Haas, None

B. Knepper, None

S. Stella, None

L. Cervantes, None

C. Price, None

W. Burman, None

P. Mehler, None

T. Jenkins, None

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