title: Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia.
abstract: BACKGROUND
  Initial management of community-acquired pneumonia (CAP) has been a Centers for Medicare and Medicaid Services performance measure for a decade. We hypothesized that an intervention directed at management of CAP that assesses areas not covered by the performance measures-treatment duration and antimicrobial selection after additional microbiology data are available--would further improve CAP management.
  
  
  METHODS
  We performed a single-center, prospective study to compare management of adult inpatients with presumed CAP before (from 1 January 2008 through 31 March 2008) and after (from 1 February 2010 through 10 May 2010) an intervention consisting of education and prospective feedback to teams regarding antibiotic choice and duration. The primary outcome measure was duration of antibiotic therapy in the 2 periods.
  
  
  RESULTS
  There were 62 patients in the preintervention period and 65 patients in the intervention period. The duration of antibiotic therapy decreased from a median of 10 to 7 days (P < .001), with 148 fewer days of antibiotic therapy. The median lengths of stay were similar in the 2 groups (4 vs 5 days). A causative pathogen was identified less frequently during the intervention period (14% vs 34%); however, antibiotics were more frequently narrowed or modified on the basis of susceptibility results during the intervention period (67% vs 19%). Fewer patients received duplicate therapy within 24 hours in the intervention period (90% vs 55%).
  
  
  CONCLUSIONS
  The duration of therapy for CAP was excessive at our institution and was decreased with a stewardship intervention. Confirmatory studies at other institutions are needed; efforts to assess and reduce duration of therapy for CAP should be strongly considered.
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-5425, USA. eavdic1@jhmi.edu
authors.forename: Edina
authors.initials: E
authors.lastname: Avdic
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cushinotto
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Hughes
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Hansen
authors.forename: Leigh E
authors.initials: LE
authors.lastname: Efird
authors.forename: John G
authors.initials: JG
authors.lastname: Bartlett
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D004358:Drug Therapy / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents