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.
M. Katzman, None