title: Evaluating the impact of an antimicrobial stewardship program on the length of stay of immune-competent adult patients admitted to a hospital ward with a diagnosis of community-acquired pneumonia: A quasi-experimental study.
abstract: The purpose of this study was to demonstrate an antimicrobial stewardship intervention can reduce length of stay for patients admitted to hospital with community-acquired pneumonia (CAP).
  
  
  
  Starting April 1, 2013, consecutive adult patients with CAP admitted to an acute care community hospital in Barrie, Ontario, Canada, were eligible for enrollment until March 31, 2015. The antimicrobial stewardship intervention was a prospective audit and feedback recommendation implemented in a stepped-wedge design across 4 wards. The primary outcome was time to hospital discharge, and secondary outcomes included time to antibiotic discontinuation and a composite outcome of 30-day readmission or all-cause mortality. The intervention effect was estimated by survival (time to discharge and antibiotic discontinuation) and logistic (30-day readmission or all-cause mortality) regression analyses.
  
  
  
  Complete data were available for 763 patients. The primary outcome was observed in 196 (82%) control patients and 402 (77%) intervention patients. Length of stay was reduced by 11% (95% confidence interval [CI], -9% to 35%). Time to antibiotic discontinuation was shortened by 29% (95% CI, 10%-52%). Odds ratio for 30-day readmission or all-cause mortality was 0.79 (95% CI, 0.49-1.29).
  
  
  
  A prospective audit and feedback intervention did not significantly reduce length of hospital stay in CAP patients despite reducing overall antibiotic utilization.
authors.affiliation: Department of Critical Care Medicine, Royal Victoria Regional Health Centre, Barrie, ON, Canada. Electronic address: didiodatog@rvh.on.ca.
authors.forename: Giulio
authors.initials: G
authors.lastname: DiDiodato
authors.affiliation: Pharmacy, Royal Victoria Regional Health Centre, Barrie, ON, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: McArthur
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Joseph
authors.initials: J
authors.lastname: Beyene
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D009864:Ontario; D011014:Pneumonia / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Community-acquired pneumonia; antimicrobial stewardship; length of stay; prospective audit and feedback; stepped-wedge design; time-variant survival analysis