Abstract Background Evidence suggests a 3‐day total duration and early transition to oral therapy is safe in hospitalized patients with community acquired pneumonia (CAP)—though such care is not standard in the United States. To implement these evidence‐based practices, a multidisciplinary group led by a hospitalist and antimicrobial stewardship updated an order set targeted at non‐intensive care unit (ICU) patients with CAP. Objective Here, we assess the impact of our intervention on diagnostic and antibiotic treatment measures and associated clinical outcomes. Methods This is a retrospective, pre/post, observational quality improvement study of non‐ICU inpatients with CAP admitted to a single academic medical center. The order set defaulted to 1 day of ceftriaxone without empiric atypical coverage for most patients, automatic de‐escalation to oral amoxicillin on Day 2, a shortened total antibiotic duration of 3 days, and appropriate laboratory utilization. Primary outcomes were antibiotic duration and azithromycin use. Clinical outcomes were also assessed. Results The pre (1/2019–12/2021, n = 777) and post (1/2022–12/2023, n = 1416) intervention periods were compared using generalized linear models and interrupted time series adjusted for known confounders. After implementation of the orderset, total antibiotic duration (6–5 days, adjusted rate ratio: 0.92, 95% confidence interval CI: 0.89–0.95, p < 0.01) and azithromycin use (62.4% 485/777 to 39.4% 558/1416, adjusted odds ratio: 0.39, 95% CI: 0.33–0.47, p < 0.01) were significantly lower. Clinical outcomes were not significantly different postintervention. Conclusions An order set backed by stewardship and hospitalists improves appropriate antibiotic use, showing that ongoing data‐driven refinements can sustain stewardship and support the safety of shorter, narrower antibiotics for CAP in real‐world care.
Ciarkowski et al. (Tue,) studied this question.