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Multicenter Stewardship Initiative Reduces Antibiotic Use for Community-Acquired Pneumonia

To improve the situation, the researchers embarked on a stewardship initiative. In a novel twist, the initiative was not carried out within the four walls of a single institution, but rather was a group effort involving Michigan Medicine in Ann Arbor, Froedtert Hospital in Milwaukee, Wisconsin, and Ochsner Medical Center in Jefferson, Louisiana.

The primary objective was to assess the impact of the multifaceted stewardship intervention on the duration of antibiotic therapy for CAP. Secondary outcomes were effects of the intervention on patient outcomes and compliance with the IDSA/ATS recommendations concerning treatment duration before (n=307) and after (n=293) the stewardship initiative was launched.

Patients were included if they had a diagnosis of CAP, age ≥18 years, and had been admitted to 1 of the 3 hospitals. The stringent exclusion criteria were intended to whittle out those with illnesses that compromised CAP diagnosis and treatment.  

As part of the initiative, when a patient achieved the IDSA/ATS criteria, a pharmacist member of the antimicrobial stewardship team contacted the primary care personnel. This allowed the compliance with the guideline recommendation concerning treatment duration to be determined.

The patients in the group prior to initiation of the stewardship intervention (control group) and the intervention group were similar demographically, with the exceptions of increased prevalence of myocardial infarction and chronic pulmonary disease in the intervention group, and increase steroid use in the control group.

The length of antibiotic therapy was 5 to 6 days in most of the control group (96.4%) and the intervention group (92.4%). The initiative essentially fit the duration of therapy more into the first few days. Before the initiative, the therapy could be prolonged, with a median of 9 days duration. The median duration after the initiative was rolled out was 6 days following implementation (P < .001). Median excess antibiotic days were reduced from 3 to 1 (P < .001).

There were no differences in hospital readmission or death between the groups, and no case of C. difficile infection.

“Active disease-based stewardship strategies are labor-intensive and require daily dedicated antimicrobial stewardship team time and resources. The multicenter nature of our initiative allowed for pooling of resources and sharing of information and tools,” said Dr. Foolad.

Although the guideline concordance increased significantly, the majority of patients were still not receiving appropriate therapy. Steps that could improve this include follow-up recommendation on the last day of appropriate therapy, notes and alerts in the electronic medical record, and stop dates for antibiotic agents.

“Further evaluations into inter-hospital partnerships for stewardship efforts are worthwhile,” Dr. Foolad noted.
Farnaz Foolad: none

Oral Abstract Session: Thinking Beyond Your Hospital: Stewardship on a Broader Scale
A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia. Farnaz Foolad, PharmD, The University of Texas MD Anderson Cancer Center, Houston, TX
Brian Hoyle, PhD, is a medical and science writer and editor from Halifax, Nova Scotia, Canada. He has been a full-time freelance writer/editor for over 15 years. Prior to that, he was a research microbiologist and lab manager of a provincial government water testing lab. He can be reached at
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