1435. Evaluating the impact of an antimicrobial stewardship program on the length of stay of immune-competent adult patients admitted to a hospital ward with a diagnosis of community-acquired pneumonia: A pragmatic clinical trial
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • 1435_IDWPOSTER.pdf (560.5 kB)
  • Background:    Pneumonia accounts for a large proportion of hospital admissions and antibiotic utilization.  Physician adherence with evidence-based pneumonia management guidelines is poor.  Antimicrobial stewardship programs (ASP) are an effective intervention to mitigate against unwarranted variation from these guidelines.  Despite this benefit, ASP have not been shown to reduce the length of stay of hospitalized patients with pneumonia.

    Methods: Pragmatic clinical study in a 339-bed hospital located in Ontario, Canada.  Starting on April 1, 2013 and ending March 31, 2015, all consecutive immune-competent adult patients (>18 years old) admitted to hospital with pneumonia were eligible for enrollment.  The ASP intervention was a prospective audit and feedback recommendation implemented in a non-randomized stepped wedge design across 4 wards and modeled as a time-dependent variable.  The primary outcome was time to hospital discharge and secondary outcomes included time to antibiotic discontinuation and composite of 30-day re-admission or all-cause mortality.  Effect on outcomes was evaluated using survival (time to discharge and antibiotic discontinuation) and logistic (30-day re-admission and all-cause mortality) regression analyses.       

    Results: Complete data was available for 763 patients.  Primary outcome was observed in 196 (82%) control and 402 (77%) intervention patients.  Competing risks survival analysis of the primary outcome demonstrated a sub-distribution hazard ratio (SHR) of 1.08 (95% CI 0.80, 1.46) for patients exposed to the intervention.  There was significant effect on days and duration of antimicrobial therapy (SHR 1.29 (95% CI 1.10, 1.52) and 1.65 (95% CI 1.42, 1.93), respectively).  A SHR > 1 should be interpreted as a reduction in time to hospital discharge or antibiotic discontinuation.  There was no significant effect on 30-day re-admission or all-cause mortality (OR 0.79 (95% CI 0.49, 1.29)).    

    Conclusion: A prospective audit and feedback ASP intervention did not reduce length of hospital stay in patients with pneumonia despite reducing overall antibiotic utilization.

    Giulio Didiodato, MSC, MD, MPH, Critical Care Medicine, Royal Victoria Regional Health Centre, Barrie, ON, Canada, Leslie Mcarthur, BPhm, Pharmacy, Royal Victoria Regional Health Centre, Barrie, ON, Canada, Joseph Beyene, PhD, McMaster University, Hamilton, ON, Canada, Marek Smieja, MD, PhD, St. Joseph's Healthcare/McMaster University, Hamilton, ON, Canada and Lehana Thabane, PhD, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada

    Disclosures:

    G. Didiodato, None

    L. Mcarthur, None

    J. Beyene, None

    M. Smieja, None

    L. Thabane, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.