title: Impact of Combination Antibiogram and Related Education on Inpatient Fluoroquinolone Prescribing Patterns for Patients With Health Care-Associated Pneumonia.
abstract: BACKGROUND
  Previous studies have shown that development of a unit-specific combination antibiogram improves optimal selection of empiric therapy for Gram-negative infections, yet no published data exist regarding the role of the combination antibiogram as an antimicrobial stewardship program tool for disease-specific prescribing.
  
  
  OBJECTIVE
  To evaluate the utility of a combination antibiogram to guide antibiotic prescribing for patients with health care-associated pneumonia (HCAP).
  
  
  METHODS
  This was a retrospective preprovider and postprovider education intervention study aimed to evaluate fluoroquinolone (FQ) use in patients with HCAP. Data were collected retrospectively to evaluate antibiotic prescribing patterns and patient outcomes.
  
  
  RESULTS
  A total of 87 patients were eligible for study inclusion. The primary end point, FQ days of therapy (DOT) was decreased by 2.3 days (P < 0.001). The secondary end point included FQ DOT per 1000 patient-days in patients with discharge diagnosis-related group of pneumonia and was decreased by 83.5 days (P = 0.08); double coverage reduced by 13% postintervention (P = 0.22); mean days of double coverage decreased by 2.1 days (P < 0.001), and length of stay was shortened by 2.1 days (P = 0.22). Clinical success was achieved more often in the postintervention group (90% vs 98%, P = 0.18) when compared with the preintervention group. No difference was found in microbiological outcomes in the subset of microbiologically evaluable patients (P = 0.57).
  
  
  CONCLUSIONS
  Facility-specific combination antibiograms may be used to inform antibiotic prescribing in HCAP patients.
authors.affiliation: Novant Health Presbyterian Medical Center, Charlotte, NC, USA.
authors.forename: Baoqi
authors.initials: B
authors.lastname: Liang
authors.affiliation: University of Tennessee, Nashville, TN, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Wheeler
authors.affiliation: Novant Health Presbyterian Medical Center, Charlotte, NC, USA lmblanchette@novanthealth.org.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Blanchette
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D003953:Diagnosis-Related Groups; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: antimicrobial stewardship; combination antibiogram; double coverage; fluoroquinolone; health care–associated pneumonia