Evaluation of multifaceted interventions on antibiotic prescribing in community-acquired pneumonia

Abstract Objective: To evaluate the impact of systemwide antimicrobial stewardship interventions on antibiotic prescribing patterns for community-acquired pneumonia(CAP) in a community health system. Design: Retrospective pre-post implementation study. Setting: Adult acute care hospitals in a community health system. Patients: Adults 18 years or older admitted to an acute care hospital with a diagnosis of CAP identified by ICD-10 codes. Methods: This retrospective, pre-post implementation study was completed at four adult acute care hospitals in a community health system. Antimicrobial stewardship interventions targeted toward CAP were rolled out between July 2020 and March 2021. Data to capture prescribing habits was collected pre and postimplementation. The inclusion criteria were patients who were at least 18 years old, admitted to an adult acute care hospital, and diagnosed as CAP based on ICD-10 code, while exclusion criteria were patients who were transferred from another hospital, had a pneumonia with an onset of 48 hours or later after admission, or had a concomitant non-respiratory tract infection during receipt of antibiotics for CAP. The primary outcome was percentage of patients who received empiric anti-MRSA or antipseudomonal antimicrobial coverage for CAP in accordance with current guideline recommendations. Results: Four hundred patients were included in the analysis, with 207 patients in the preimplementation arm and 193 patients in the postimplementation arm. The percentage of patients who received appropriate empiric coverage significantly increased from 34.7% in the preimplementation group to 60.1% in the postimplementation group ( P < .0001). Conclusions: Multifaceted antimicrobial stewardship interventions significantly improve guideline-concordant empiric MRSA and P. aeruginosa antimicrobial coverage.