Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Optimizing the duration of antibiotic therapy at hospital discharge is an important community-acquired pneumonia (CAP) stewardship intervention, as prolonged courses contribute to resistance and harm. Current guidelines recommend five days of therapy in patients with clinical resolution of symptoms.
Research Question or Hypothesis: The purpose of this medication use evaluation was to determine the appropriateness of CAP antibiotic duration.
Study Design: This was an Institutional Review Board-exempt, retrospective chart review conducted at a community teaching hospital between July 1 and December 31, 2022.
Methods: Patients were included if they were at least 18 years old and had a CAP diagnosis. Patients were excluded if they had a concomitant infection, intensive care unit admission, or sepsis diagnosis. Electronic medical records and online medication history data were reviewed. The primary outcomes were to assess total antibiotic duration and duration at discharge. The number of days of inpatient and discharge antibiotics was collected and compared to clinical practice guidelines. Secondary outcomes were to describe discharge antibiotic regimens, quantify medication errors, and assess 30-day readmissions for pneumonia and Clostridioides difficile (C. diff). Descriptive statistics were used.
Results: A total of 321 hospital admissions were assessed, and 50 met inclusion criteria. The average length of hospital stay was 4.27 days. The average total duration of antibiotic therapy was 8.53 days, while the average duration of discharge antibiotic therapy was 4.89 days. Discharge regimens most commonly included doxycycline (20%) and amoxicillin-clavulanate (18%). A total of 31 errors were detected in discharge antibiotics; most were due to excessive treatment duration. Two patients were readmitted for pneumonia within 30 days, and none developed C. diff.
Conclusion: Similar to previous findings demonstrating antibiotic overuse at hospital discharge, many patients received a prolonged course of therapy. The opportunity to optimize discharge antibiotic prescribing for CAP exists.
Presenting Author
Lindsay Brust-Sisti Pharm.D., BCPSErnest Mario School of Pharmacy, Rutgers, The State University of New Jersey
Authors
Nicole Leonida Pharm.D., BCPS, BCIDP
Jersey City Medical Center