Methods: A retrospective, pre-intervention/post-intervention study was conducted to compare management for patients admitted with CAP before and after implementation of the ASP-bundled initiative. The pre-intervention period was March 1, 2014 through October 31, 2014, and the intervention period was September 1, 2015 through April 30, 2016.
Results: A total of 39 and 61 patients were included in the pre-intervention and post-intervention cohorts, respectively. When compared with the pre-intervention group, mean duration of therapy decreased (9.0 vs 5.6 days; P < 0.001). More patients received an appropriate duration of 7 days or less (38.5% vs 80.3%; P < 0.001), while fewer received courses of more than 10 days (28.2% vs 3.3%; P < 0.001). Fewer patients received intravenous vancomycin (28.2% vs 4.9%; P = 0.002) and anti-pseudomonal beta-lactams (25.6% vs 6.6%; P = 0.02). Pneumonia-related 30-day re-admission rates (5.1% vs 4.9%; P = 0.99) were unaffected. In the post-intervention group, patients with procalcitonin levels < 0.25µg/L received shorter duration of therapy compared to patients with levels > 0.25µg/L (4.5 vs 6.9 days; P = 0.001).
Conclusion: A syndrome-specific approach to antimicrobial stewardship practices, incorporating procalcitonin-guidance, led to shorter durations of therapy and decreased use of broad-spectrum antibiotics for the treatment of CAP without affecting hospital re-admissions.
H. Bean, None
C. Watson, None
D. Bremmer, None