A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)
Authors: Foolad Farnaz , Huang Angela , Nguyen Cynthia , Colyer Lindsay , Lim Megan , Grieger Jessica , Revolinski Sara , Li Julius , Mack Megan , Gandhi Tejal , Wainaina J Njeri , Eschenauer Gregory , Patel Twisha , Marshall Vince , Nagel Jerod 
Published: October 2017

Abstract

Background
Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged.

Methods
The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations.

Results
A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P&lt; &lt; 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P &lt; 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P &lt; 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups.

Conclusion
This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes.
This project was funded through a competitive stewardship grant provided by Merck & Co.

Disclosures
A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant