Effects of a Syndrome-Specific Antibiotic Stewardship Intervention for Inpatient Community-Acquired Pneumonia

Haas, Michelle; Dalton, Kristen; Knepper, Bryan; Stella, Sarah A; Cervantes, Lilia; Price, Connie S.; Burman, William J.; Mehler, Philip S.; Jenkins, Timothy C

doi:10.1093/ofid/ofw186

Cited by 25 publications

(18 citation statements)

References 33 publications

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“…Interestingly, the greatest changes in prescribing were observed in CAP and skin infections, conditions for which successful syndrome-specific antibiotic stewardship interventions had been implemented in our hospital prior to the pre-intervention period of this study [4, 16]. These prior interventions had led to substantial reductions in use of antibiotics with broad gram-negative activity and shorter treatment durations.…”

Section: Discussionmentioning

confidence: 99%

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Yogo

Shihadeh

Young

et al. 2017

Infect. Control Hosp. Epidemiol.

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Objective For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Post-discharge therapy is often unnecessarily broad-spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations. Design Single center, quasi-experimental retrospective cohort study. Methods Patients prescribed oral antibiotics at hospital discharge before (July 2012 – June 2013) and after (October 2014 – February 2015) an intervention consisting of: 1) institutional guidance for oral step-down antibiotic selection and duration of therapy, and 2) pharmacy audit of discharge prescriptions with real-time prescribing recommendations to providers. The primary outcomes were total prescribed duration of therapy and use of antibiotics with broad gram-negative activity (fluoroquinolones or amoxicillin-clavulanate). Results 300 cases from the pre-intervention period and 200 from the intervention period were included. Compared with the pre-intervention period, use of antibiotics with broad gramnegative activity decreased during the intervention (51% vs 40%, p = 0.02), particularly fluoroquinolones (38% vs 25%, p = 0.002). The difference in total duration of therapy did not reach statistical significance (10 days [interquartile range (IQR) 7–13] vs 9 [IQR 6–13], p = 0.13); however, the duration prescribed at discharge declined from 6 days (IQR 4–10) to 5 (IQR 3–7) (p = 0.003). During the intervention, there was a non-significant increase in the overall appropriateness of discharge prescriptions (52% vs 66%, p = 0.15). Conclusions A multifaceted intervention to optimize antibiotic prescribing at hospital discharge was associated with less frequent use of antibiotics with broad gram-negative activity and shorter post-hospital treatment durations.

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Section: Discussionmentioning

confidence: 99%

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Yogo

Shihadeh

Young

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…Recent guidelines recommend that antimicrobial stewardship programs implement syndrome-specific interventions to improve antibiotic use and clinical outcomes. 11,12 Urinary tract infections (UTI) and respiratory tract infections, particularly health care−associated pneumonia (HCAP), are common syndromes that offer a great opportunity to address the problem of inappropriate fluoroquinolone use. [13][14] Fluoroquinolone are often prescribed for these syndromes when alternative antibiotics may be more appropriate.…”

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confidence: 99%

Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: An interrupted time series analysis

Hecker

Son

Murphy

et al. 2019

American Journal of Infection Control

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Background: Fluoroquinolones are often prescribed unnecessarily and are an important risk factor for infection with fluoroquinolone-resistant gram-negative bacilli and Clostridioides difficile. Methods: We conducted a quasi-experimental study to determine the impact of sequential syndrome-specific stewardship interventions on use of and resistance to fluoroquinolones in a tertiary care hospital. An initial 2-year intervention focused on reducing treatment of asymptomatic bacteriuria and ensuring concordance of urinary tract infection treatment with guidelines. A second 5-year intervention focused on limiting overuse of fluoroquinolones for health care−associated pneumonia in conjunction with a formal stewardship program. The primary outcomes were fluoroquinolone use and changes in use over time analyzed by segmented regression analysis. Results: The asymptomatic bacteriuria and urinary tract infection intervention resulted in a significant reduction in fluoroquinolone use, with a significant change from an increasing to a decreasing rate of use (change in slope of quarterly defined daily doses/1,000 patient days −15.3, P < .01). The health care−associated pneumonia intervention resulted in a continued significant reduction in fluoroquinolone use (rate ratio = 0.68, P < .01). During the interventions, fluoroquinolone susceptibility increased significantly in Pseudomonas aeruginosa, but not in Escherichia coli, Klebsiella spp., or C difficile. Conclusions: Antimicrobial stewardship interventions focused on specific syndromes may be effective in reducing fluoroquinolone use. In our hospital, reduction in fluoroquinolone use resulted in increased fluoroquinolone susceptibility in P aeruginosa, but not other Enterobacteriaceae or C difficile.

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“…Previous studies show that the average length of antibiotic therapy (LOT) for CAP in the United States exceeds IDSA–ATS guidelines of 5–7 days among adults hospitalized for CAP, suggesting a potentially important opportunity to improve antimicrobial stewardship. However, these studies were not generalizable to the US population [6–11]. Here, we used nationwide data to determine the LOT most commonly used for treatment of patients hospitalized for CAP in the United States.…”

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confidence: 99%

Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

Hatfield

Baggs

et al. 2017

Clinical Infectious Diseases

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Effects of a Syndrome-Specific Antibiotic Stewardship Intervention for Inpatient Community-Acquired Pneumonia

Abstract: A syndrome-specific intervention to improve the management of community-acquired pneumonia in non-intensive care settings was associated with shorter treatment durations, less fluoroquinolone use, and a reduction in use of low-yield diagnostic tests.

Cited by 25 publications

References 33 publications

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: An interrupted time series analysis

Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

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