Scientific Poster Session IV - Original Research

Original Research
  Tuesday, November 14, 2023
  08:30 AM–10:00 AM

Abstract

Introduction: Antibiotic inertia has been defined as the tendency of inpatient providers to continue antibiotics chosen in the Emergency Department (ED) regardless of appropriateness. Patients presenting with community-acquired pneumonia (CAP) may frequently meet sepsis criteria, and current sepsis guideline recommendations may contribute to early broad antibiotic selection.

Research Question or Hypothesis: Do patients with CAP started on broad spectrum antibiotics by the ED provider (EDP) experience more antibiotic inertia when compared to patients initially started on narrow therapy?

Study Design: Retrospective chart review of adults admitted to Methodist University Hospital in Memphis, TN for initial treatment of CAP between January 1, 2020 and July 1, 2022, who were started on antibiotics by an EDP.

Methods: Broad antibiotic coverage was defined as antibiotics covering MRSA or Pseudomonas. Patients were excluded if no antibiotics were started by the EDP, immediate admission to the ICU, multiple indications for antibiotics, or positive for COVID during the visit.

Results: Of the 111 patients included, 75 were in the ED narrow therapy group (67.6%) and 36 in the broad therapy group (32.4%). Overall, 54% of patients met sepsis criteria on presentation. The rate of antibiotic inertia was significantly higher in the narrow therapy group (52% vs. 16.7%; p<0.001). The narrow therapy group was more likely to be on appropriate inpatient antibiotics (65.7% vs. 32.4%; p<0.001). Patients started on broad therapy in the ED had longer durations of antibiotics (9.6 days vs. 6.6 days; p<0.001). Use of a “sepsis bundle” order-set was associated with a higher rate of broad therapy (32% vs. 63.9%, p<0.001).

Conclusion: There was an increased rate of antibiotic inertia in patients that received narrow therapy from an EDP. Most patients started on narrow therapy were receiving guideline-based therapy for CAP. Initiation of broad therapy antibiotics in the ED was associated with longer durations of therapy.

Presenting Author

Tara Parnacott PharmD
Methodist University Hospital

Authors

Dennis Marjoncu PharmD BCOP
Methodist University Hospital

Lisa Hayes PharmD, BCCCP
Methodist University Hospital

Anna Jacobs PharmD, BCPS
Methodist University Hospital