908. Optimization of Pneumonia Treatment in an Intensive Care Unit Utilizing a Pharmacist-Driven Protocol
Session: Oral Abstract Session: Pneumonia from Soup to Nuts
Friday, October 28, 2016: 9:15 AM
Room: 288-290
Background: Bacterial pneumonia is one of the most common reasons for hospital admission, associated with increased costs and an average length of stay of 5.2 days. Treatment recommendations vary from five to twenty-one days. Current literature regarding community acquired and hospital acquired pneumonia indicate longer antimicrobial therapy does not improve clinical or microbiological outcomes. The objective of this study is to evaluate patient outcomes following implementation of a pharmacist-driven protocol for the treatment of pneumonia in an intensive care unit (ICU).

Methods: This study was conducted at Franciscan St. Francis Health, a 500-bed community hospital with 30 medical ICU beds. This is a retrospective review of patients admitted to the medical ICU with a diagnosis of pneumonia between January 2014 - January 2016. Patients were divided into two groups: historical control group (pre-intervention-PRE) and post-protocol implementation (intervention group-INT). Baseline characteristics, cultures collected, days of antibiotic therapy, length of ICU stay, overall length of stay, mortality and 30 day readmission were compared.

Results:The PRE group included 134 patients and the INT group included 67 patients. Baseline characteristics between groups were similar. Average days of therapy were less in the INT compared to the PRE: ßeta-lactam, 6.72 ± 2.48 vs 7.37 ± 3.93; atypical, 4.25 ± 1.61 vs 4.36 ± 1.97; anti-MRSA, 3.80 ± 1.88 vs 4.66 ± 2.95; and aminoglycosides, 1.70 ±1.28 vs 2.32 ± 1.85. However, none of these differences reached statistical significance. Total average days of therapy were significantly less in the INT, 12.31 ± 6.54, as compared to the PRE, 15.88 ± 6.93, p <.001. Patients in the PRE were more likely to receive greater than 7 days of antibiotics, OR 3.7 (1.5-9.0). Comparing INT to PRE there was no difference in mortality (17.9% vs 17.9%, p=1.0), length of ICU stay (4.31 ± 3.44 vs 4.88 ± 4.48, p=.364) overall length of stay ( 8.05 ± 5.36 vs 8.47 ± 5.75, p=.627) or 30 day readmission (9.0%vs 8.2%, p=.858).

Conclusion: Implementation of a pharmacist-driven protocol for treatment of pneumonia in a medical ICU reduced days of antibiotic therapy without increasing length of stay or mortality in this single-center study.

Maureen Campion, PharmD1, Kevin Sponsel, PharmD, BCPS2, Andrea H Stock, PharmD, BCPS3, Imad Shawa, MD4, Richard Need, MD5 and S. Christian Cheatham, PharmD1, (1)Pharmacy, Franciscan St. Francis Health, Indianapolis, IN, (2)Pharmacy, Byran Health, Lincoln, NE, (3)Pharmacy, Columbus Regional Health, Columbus, IN, (4)Critical Care, Franciscan St. Francis Health, Indianapolis, IN, (5)Franciscan St. Francis Health, Indianpolis, IN

Disclosures:

M. Campion, None

K. Sponsel, None

A. H. Stock, None

I. Shawa, None

R. Need, None

S. C. Cheatham, None

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