S2. Antimicrobial Stewardship outcomes assessment (clinical and economic)
Oral Abstract Submission
Anurag N. Malani, MD, FIDSA, FSHEA
Medical Director, Infection Prevention & Antimicrobial Stewardship Programs
St. Joseph Mercy Health System, Ann Arbor
Ann Arbor, Michigan
Disclosure: Nothing to disclose
Background : Most patients hospitalized with community-acquired pneumonia (CAP) can be safely treated with 5 days of antibiotics, but many are not. We determined whether a hospitalist-collaborative can reduce excess antibiotic duration in patients with CAP through partnership with antibiotic stewardship teams (AST), data feedback, pay-for-performance, and sharing best practices.
Methods : From 4/2017-10/2018, abstractors collected data (medical record, phone calls 30-days post-discharge) on adult, non-ICU patients hospitalized with CAP at 43 hospitals in Michigan. We used a guideline-based algorithm1 to determine appropriate antibiotic duration based on patient factors (e.g., clinical stability). All hospitals received a) quarterly reports on appropriate 5-day treatment rates (2016—current), b) best practice recommendations (2017—current) including toolkit and webinar (3/2018), and c) pay-for-performance based on 5-day CAP metric (2018—current). Generalized linear mixed models were used to evaluate change over time in a) proportion of patients with CAP eligible for 5-day treatment who received 5 ± 1 days and, after adjusting for patient factors and weighting by inverse probability of treatment, b) patient outcomes 30-days post-discharge.
Results : Of 6229 patients hospitalized with CAP, 4769 (76.6%) were eligible for 5-days of antibiotic treatment; 283 (5.9%) were excluded due to inability to determine antibiotic duration. Between 4/2017 and 10/2018, the proportion of patients eligible for a 5-day duration of antibiotic treatment who received 5 ± 1 days increased from 19.8% (181/914) to 30.9% (207/670; P=0.01), a relative improvement of 56.1% (Figure 1). During this time period, there were no changes in 30-day post-discharge death, readmission, emergency room visit, Clostridioides difficile infection, or provider-documented antibiotic-associated adverse-events (Table 1). However, there was a decrease (3.3% to 1.7%, P=0.03 for change over time; relative reduction: 48.5%) in patient-reported antibiotic-associated adverse-events (Figure 2).
A hospitalist collaborative partnering with AST can safely reduce excess antibiotic duration and antibiotic-associated adverse-events in hospitalized patients with CAP.