Effects of a three-part antimicrobial stewardship intervention on duration of treatment of pneumonia in a primary hospital setting

Introduction: Our facility’s antibiotic duration for the treatment of uncomplicated pneumonia was previously shown to be, on average, longer than what is recommended in current guidelines.  Based on these results, our facility implemented a three-part antimicrobial stewardship intervention.  This study was conducted to test the effectiveness of this initiative.

Objectives: To determine if a multifaceted stewardship intervention could reduce antibiotic treatment duration of pneumonia closer to that recommended by national guidelines. The primary endpoint was change in total antibiotic duration.  Secondary endpoints were duration of intravenous (IV) antibiotic therapy, duration of outpatient antibiotic therapy, and mean length of stay.

Study Design: This was a retrospective, before and after chart review. 

Methods: Medical records of 103 patients were reviewed to establish our baseline prescribing practices (group 1).  Our intervention consisted of 1) provider education of baseline results and review of current guidelines, 2) prospective intervention and feedback during daily hospital admissions, and 3) the development of a stewardship note/template with reminders of clinical stability and duration of current therapy.  Medical records of 88 patients were then reviewed after implementation of our stewardship strategy (group 2).

Results: Duration of antibiotic therapy was significantly decreased in both community acquired pneumonia (11.1 days vs 8.4 days, p<0.0001) and healthcare associated pneumonia (11.8 days vs 8.8 days, p=0.002).  Inpatient duration of IV antibiotics were decreased (3.8 days vs 2.7 days, p<0.0001) as well as outpatient antibiotic duration (6.3 days vs 4.7 days, p=0.001).  Mean length of stay was shorter in the follow up group (4.9 days vs 4.0 days, p=0.02).

Conclusions: A three-part stewardship intervention can successfully shorten duration of antibiotic therapy to be more consistent with that recommended by current guidelines for uncomplicated pneumonia in a primary hospital setting.