1029. Impact of a Multi-Faceted Stewardship Intervention on Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Background: IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest unnecessarily long durations of antibiotics are commonly prescribed. Additionally, opportunities exist to decrease the use of fluoroquinolones and ceftriaxone, agents considered high-risk for the development of Clostridium difficile infection (CDI).

Methods: The objective of this quasi-experimental study of hospitalized patients with CAP was to assess the impact of a multifaceted stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. The intervention consisted of updating institutional CAP guidelines to promote guideline-concordant durations of therapy and to give preference to the use of agents with low risk for CDI; providing education to pharmacists and prescribers; and performing prospective audit with feedback by stewardship pharmacists to optimize compliance with guideline recommendations.

Results: A total of 187 patients were included (93 in the historic control group and 94 in the stewardship intervention group). Stewardship intervention significantly improved duration of therapy compliance (10 vs 37%, p<0.001), reduced total antibiotic days of therapy by 13.3% (803 vs. 696 days), and decreased the median duration of therapy (8 vs. 7 days, p<0.001). Stewardship intervention also reduced the utilization of high CDI risk antimicrobial agents, including initial therapy and oral-step down therapy: ampicillin/sulbactam and amoxicillin/clavulanate utilization increased in the stewardship intervention group, with corresponding decreased use of ceftriaxone, cefpodoxime, and levofloxacin (p<0.05). There were no statistical differences in clinical outcomes, including mortality, length of stay, readmission for pneumonia, or incidence of CDI.

Conclusion: This stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and reduced the utilization of high-risk CDI antibiotics, without adversely affecting clinical outcomes.

Farnaz Foolad, PharmD1, Angela Huang, PharmD, BCPS-AQ ID2, Cynthia Nguyen, PharmD3, Megan Mack, MD1, Tejal Gandhi, MD4, Gregory Eschenauer, PharmD1, Twisha Patel, PharmD1, Vince Marshall, BS, MS1, Lindsay Colyer, P4 Student1, Megan Lim, P4 Student1 and Jerod Nagel, PharmD1, (1)University of Michigan Health System, Ann Arbor, MI, (2)Froedtert & the Medical College of Wisconsin, Milwaukee, WI, (3)Ochsner Health System, Jefferson, LA, (4)Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI


F. Foolad, None

A. Huang, None

C. Nguyen, None

M. Mack, None

T. Gandhi, None

G. Eschenauer, None

T. Patel, None

V. Marshall, None

L. Colyer, None

M. Lim, None

J. Nagel, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.