title: Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia.
abstract: Carbapenems have an overall broad antibacterial spectrum and should be protected against from the acquisition of drug resistance. The clinical advantages of carbapenem in cases of pneumonia have not been certified and the need for antipseudomonal antimicrobial agents to treat healthcare-associated pneumonia (HCAP) remains controversial. We introduced an antimicrobial stewardship program for carbapenem and tazobactam/piperacillin use and investigated the effects of this program on the clinical outcomes of 591 pneumonia cases that did not require intensive care unit management, mechanical ventilation or treatment with vasopressor agents [221 patients with community-acquired pneumonia (CAP) and 370 patients with HCAP]. Compared with the pre-intervention period, age, comorbidities and the severity and etiology of pneumonia did not differ during the intervention period. Carbapenems were rarely used during the intervention period in cases of pneumonia (CAP: 12% vs. 1%, HCAP: 13% vs. 1%), while antipseudomonal beta-lactam use was reduced from 33% to 8% among cases with HCAP. This reduction in the rate of carbapenem administration did not have an impact on the prognosis in the cases of CAP, and the in-hospital mortality was lower among the patients with HCAP during the intervention period (15% vs. 5%, p = 0.013). The causes of death in the cases of HCAP were not directly related to pneumonia during the intervention period. The current study shows that carbapenem use can be avoided in cases of CAP or HCAP that are not in a critical condition. The frequent use of antipseudomonal beta-lactams does not improve the clinical outcomes of HCAP.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kamata
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan. Electronic address: hsuzuki@tmch.or.jp.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kanemoto
authors.affiliation: Japan Community Healthcare Organization, Tokyo, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.affiliation: Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shiotani
authors.affiliation: Department of General Medicine and Primary Care, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Hirose
authors.affiliation: Department of General Medicine and Primary Care, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Masatsune
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hiroichi
authors.initials: H
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016134:Organizational Policy; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D011379:Prognosis; D011552:Pseudomonas Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000077725:Piperacillin, Tazobactam Drug Combination; D010397:Penicillanic Acid; D010878:Piperacillin
keywords: Antimicrobial stewardship; Carbapenem; Community-acquired pneumonia; Healthcare-associated pneumonia