1436. Pneumonia Management and Outcomes in a Medical Intensive Care Unit Pre- and Post-Implementation of an Antimicrobial Stewardship Program
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background: The purpose of this study was to assess the impact of an antimicrobial stewardship program (ASP) on de-escalation from broad empiric coverage for pneumonia in a medical intensive care unit (MICU).

Methods: This was a retrospective cohort study of adult patients admitted to the MICU during selected months from 2009 to 2014 with a diagnosis of pneumonia who received antibiotics for at least 72 hours.  Patients were separated into two groups based on whether the MICU admission was before or after implementation of a hospital-wide ASP in April 2011.

Results: A total of 99 patients were included in the final analysis: 49 in the pre-ASP group and 50 in the post-ASP group.  Approximately 60% of patients in each group had healthcare-associated, hospital-acquired, or ventilator-associated pneumonia, and for these patients the most common empiric regimen was the triple combination of vancomycin, piperacillin-tazobactam, and ciprofloxacin.  For the entire cohort, the rate of any de-escalation (75.5% vs 76.0%) was similar between the groups; but for patients started on triple antibiotics, significantly more finished treatment on three antibiotics in the pre-ASP group than in the post-ASP group (44.8% vs 9.1%, p = 0.005) and more finished treatment on one antibiotic in the post-ASP group (41.4% in the pre-ASP group vs 68.2% in the post-ASP group, p = 0.059).  The mean time to initial de-escalation (4.3 vs 4.1 days) was similar between groups; however, there was a trend for shorter time to final de-escalation (5.7 vs 4.6 days) in the post-ASP group.  Although the 30-day mortality rates were similar (16.3% vs 14.0%), the 30-day hospital readmission rate was significantly decreased in the post-ASP group (16.3% vs 2.0%, p = 0.012), and there was a suggestion of decreased total duration of antibiotic therapy (10.0 vs 8.5 days) and MICU length of stay (9.2 vs 6.7 days).

Conclusion: Implementation of an ASP was associated with fewer pneumonia patients who were started on three antibiotics finishing on triple therapy and a lower rate of hospital readmission for the entire study group, along with trends to shorter time to final de-escalation of antibiotics, decreased duration of antibiotics, and shorter MICU length of stay, all of which are consistent with the goals of stewardship.

Michael Lehr, PharmD1, Jihye Kim, PharmD1 and Michael Katzman, MD, FIDSA2, (1)Pharmacy, Penn State Hershey Medical Center, Hershey, PA, (2)Internal Medicine, Penn State Hershey Medical Center, Hershey, PA

Disclosures:

M. Lehr, None

J. Kim, None

M. Katzman, None

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