1828. A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)
Session: Oral Abstract Session: Thinking Beyond Your Hospital: Stewardship on a Broader Scale
Saturday, October 7, 2017: 11:45 AM
Room: 01AB
Background: Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged.

Methods: The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations.

Results: A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, p<0.01) and significantly reduced the duration of therapy for CAP (9 vs 6 days, p<0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs 1.6 days, p<0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups.

Conclusion: This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes.

This project was funded through a competitive stewardship grant provided by Merck & Co.

Farnaz Foolad, PharmD1, Angela Huang, PharmD, BCPS-AQ ID2, Cynthia Nguyen, PharmD3, Lindsay Colyer, PharmD4, Megan Lim, PharmD5, Jessica Grieger, MD Student6, Sara Revolinski, PharmD, BCPS2, Julius Li, PharmD7, Megan Mack, MD4, Tejal Gandhi, MD8, J Njeri Wainaina, MD2, Gregory Eschenauer, PharmD, BCPS4, Twisha Patel, PharmD4, Vince Marshall, BS, MS4 and Jerod Nagel, PharmD, BCPS5, (1)The University of Texas MD Anderson Cancer Center, Houston, TX, (2)Froedtert & The Medical College of Wisconsin, Milwaukee, WI, (3)Ochsner Health System, Jefferson, LA, (4)Michigan Medicine, Ann Arbor, MI, (5)Department of Pharmacy, Michigan Medicine, Ann Arbor, MI, (6)The University of Queensland School of Medicine, New Orleans, LA, (7)Ochsner Medical Center, New Orleans, LA, (8)Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI

Disclosures:

F. Foolad, None

A. Huang, Merck: Grant Investigator , Research grant

C. Nguyen, Merck: Grant Investigator , Research grant

L. Colyer, None

M. Lim, None

J. Grieger, Merck: Grant Investigator , Research grant

S. Revolinski, Merck: Grant Investigator , Research grant

J. Li, Merck: Grant Investigator , Research grant

M. Mack, Merck: Grant Investigator , Research grant

T. Gandhi, None

J. N. Wainaina, Merck: Grant Investigator , Research grant

G. Eschenauer, Merck: Grant Investigator , Research grant

T. Patel, Merck: Grant Investigator , Research grant

V. Marshall, Merck: Grant Investigator , Research grant

J. Nagel, Merck: Grant Investigator , Research grant

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