SHM Converge Scientific Abstract ePoster Gallery-Implementation of an Orderset to Improve Antibiotic Use in Hospitalized Patients With Community Acquired Pneumonia

Pdf Summary

This quality improvement study evaluated whether updating a community-acquired pneumonia (CAP) order set could improve antibiotic stewardship for hospitalized adults admitted to non-ICU units. The intervention, introduced in November 2021, changed the default regimen from azithromycin plus ceftriaxone with a 5-day course to a 3-day course with automatic de-escalation to oral amoxicillin and removal of azithromycin. Some diagnostic tests were also adjusted in the order set.<br /><br />The study included adults with a discharge diagnosis of pneumonia who received antibiotics within 48 hours of admission. Patients with early ICU admission, cystic fibrosis, transplant history, COVID-19, or unusual antibiotic durations were excluded. Outcomes were compared before and after the intervention using regression and interrupted time series analyses, adjusting for age, comorbidity burden, and illness severity.<br /><br />After the order set update, azithromycin use decreased from 62.4% to 39.4%, and amoxicillin use increased from 5.1% to 51.1%. Median total antibiotic duration decreased from 6 to 5 days. Several diagnostic tests were ordered less often, including Streptococcus pneumoniae urine antigen, Legionella urine antigen, and blood cultures. Procalcitonin and respiratory culture use did not change significantly.<br /><br />Clinical outcomes were not worse after the intervention. Length of stay remained unchanged, ICU transfer decreased, and there was no significant increase in combined 30-day readmission and mortality. Although 30-day readmission alone increased modestly, overall findings suggested the updated order set improved antibiotic and test use without compromising patient safety.<br /><br />Overall, the study supports ongoing refinement of CAP order sets to promote shorter, narrower antibiotic therapy in appropriate non-ICU patients.

Asset Subtitle

Claire Ciarkowski

Meta Tag

Author List Chaorong Wu, Claire Ciarkowski, Emily Spivak, Karen Howard, Valerie M. Vaughn

Category Research

Concept Community-Acquired Pneumonia

Concept Antibiotic Prescribing

Concept Order Set

Concept Antibiotic Duration

Concept Interrupted Time Series

Distinguished Non-Finalist

Presenter Organization University of Utah Health

Presenting Author Claire Ciarkowski

Track Quality Improvement

Keywords

community-acquired pneumonia

antibiotic stewardship

order set intervention

azithromycin

amoxicillin

hospitalized adults

non-ICU

diagnostic testing

length of stay

readmission

Community-Acquired Pneumonia

Antibiotic Prescribing

Order Set

Antibiotic Duration

Interrupted Time Series