Initiative improves antibiotic prescribing for community-acquired pneumonia
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An initiative launched in dozens of Michigan hospitals more than doubled the rate of appropriate antibiotic prescribing for patients hospitalized with community-acquired pneumonia, researchers reported.
Such patients often receive more than 5 days of antibiotic treatment, resulting in a higher risk for adverse events, the researchers said.
“Since 2017, we’ve been seeking to improve care for hospitalized patients with infections. We found that patients often receive antibiotic therapy in excess of what they need and that this can lead to immediate, direct patient harm in terms of adverse events but also in long-term harm, like antibiotic resistance,” Valerie M. Vaughn, MD, MSc, assistant professor of medicine and director of hospital medicine research at the University of Utah School of Medicine, told Healio.
“So, we wanted to help hospitals improve their antibiotic prescribing,” Vaughn said.
Vaughn and colleagues performed a prospective collaborative quality initiative that included patients hospitalized with uncomplicated community-acquired pneumonia (CAP) who qualified for a 5-day antibiotic duration.
According to the study, between Feb. 23, 2017, and Feb. 5, 2020, the Michigan Hospital Medicine Safety Consortium “targeted appropriate 5-day antibiotic treatment through benchmarking, sharing best practices and pay-for-performance.” The researchers then assessed changes in outcomes, including appropriate receipt of a 5 (±1)-day antibiotic duration and 30-day postdischarge composite adverse events, including mortality, readmission, urgent visit and antibiotic-associated adverse events, over time using logistic regression.
In total, 41 hospitals and 6,553 patients were included in the study. Vaughn and colleagues found that the percentage of patients treated with an appropriate 5±1-day duration increased from 22.1% (95% CI, 17.2%-25%) to 45.9% (95% CI, 36.8%-51.2%) during the study.
Additionally, the study demonstrated that 30-day composite adverse events occurred in 18.5% of patients and decreased over time (adjusted OR = 0.98 per quarter; 95% CI, 0.96-0.99) because of a decrease in antibiotic-associated adverse events (aOR = 0.91 per quarter; 95% CI, 0.87-0.95).
“Most hospitalized patients with community-acquired pneumonia should get no more than 5 days of antibiotic therapy,” Vaughn said.
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