Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study.

• Type of Material: Article
• Authors: Sara Tomczyk, Epidemic Intelligence Service; Seema Jain, Centers for Disease Control and Prevention; Anna M Bramley, Centers for Disease Control and Prevention; Wesley H Self, Vanderbilt University; Evan Anderson, Emory University; Chris Trabue, University of Tennessee; D Mark Courtney, Northwestern University; Carlos G Grijalva, Vanderbilt University; Grant W Waterer, Northwestern University; Katherine Edwards, Emory University; Richard G Wunderink, Northwestern University; Lauri A Hicks, Centers for Disease Control and Prevention
• Language: English
• Date: 2017
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: This work is written by US Government employee and is in the public domain in the US.
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofx088
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 4
• Issue: 2
• Start Page: ofx088
• End Page: ofx088
• Grant/Funding Information: C. G. G. was supported in part by the National Institute on Aging (R01AG043471).; This work was supported by the Influenza Division, CDC. W. H. S. was supported in part by the National Institute of General Medical Sciences (K23GM110469).; E. J. A. was supported in part by funding from MedImmune.
• Keywords: community-acquired pneumonia.; antibiotics
• Research Categories: Health Sciences, Public Health; Health Sciences, Pharmacology

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. METHODS: From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. RESULTS: Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. CONCLUSIONS: Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.