title: Effects of a Syndrome-Specific Antibiotic Stewardship Intervention for Inpatient Community-Acquired Pneumonia.
abstract: Background.Syndrome-specific interventions are a recommended approach to antibiotic stewardship, but additional data are needed to understand their potential impact. We implemented an intervention to improve the management of inpatient community-acquired pneumonia (CAP) and evaluated its effects on antibiotic and resource utilization.Methods.A stakeholder group developed and implemented a clinical practice guideline and order set for inpatient, non-intensive care unit CAP recommending a short course (5 days) of a fluoroquinolone-sparing antibiotic regimen in uncomplicated cases. Unless there was suspicion for complications or resistant pathogens, chest computed tomography (CT) and sputum cultures were discouraged. This was a retrospective preintervention postintervention study of patients hospitalized for CAP before (April 15, 2008-May 31, 2009) and after (July 1, 2011-July 31, 2012) implementation of the guideline. The primary comparison was the difference in duration of therapy during the baseline and intervention periods. Secondary outcomes included changes in use of levofloxacin, CT scans, and sputum culture.Results.One hundred sixty-six and 84 cases during the baseline and intervention periods, respectively, were included. From the baseline to intervention period, the median duration of therapy decreased from 10 to 7 days (P< .0001). Prescription of levofloxacin at discharge decreased from 60% to 27% of cases (P< .0001). Use of chest CT and sputum culture decreased from 47% to 32% of cases (P= .02) and 51% to 31% of cases (P= .03), respectively. The frequency of clinical failure between the 2 periods was similar.Conclusions.A syndrome-specific intervention for inpatient CAP was associated with shorter treatment durations and reductions in use of fluoroquinolones and low-yield diagnostic tests.
authors.affiliation: Divisions of Infectious Diseases; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora; Denver Public Health, Colorado.
authors.forename: Michelle K
authors.initials: MK
authors.lastname: Haas
authors.affiliation: Hospital Medicine, Department of Medicine.
authors.forename: Kristen
authors.initials: K
authors.lastname: Dalton
authors.affiliation: Department of Patient Safety and Quality , Denver Health.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.affiliation: Hospital Medicine, Department of Medicine.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Stella
authors.affiliation: Hospital Medicine, Department of Medicine.
authors.forename: Lilia
authors.initials: L
authors.lastname: Cervantes
authors.affiliation: Divisions of Infectious Diseases; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora.
authors.forename: Connie S
authors.initials: CS
authors.lastname: Price
authors.affiliation: Divisions of Infectious Diseases; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora; Denver Public Health, Colorado.
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
authors.affiliation: Department of Patient Safety and Quality , Denver Health.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.affiliation: Divisions of Infectious Diseases; Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, Aurora.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
keywords: antimicrobial stewardship; community-acquired pneumonia; duration of therapy; levofloxacin; quality improvement