Impact of Antimicrobial Stewardship on Outcomes in Hospitalized Veterans With Pneumonia Open Access

Background. Pneumonia is a common cause of hospitalization. The purpose of this study is to evaluate the impact of an antimicrobial stewardship program (ASP) on outcomes for inpatients with pneumonia including length of stay, treatment duration, and 30-day readmission rates.

Methods. A retrospective chart review comparing outcomes of veterans admitted with pneumonia before (2005-2006) and after implementation (2013-2014) of an ASP was conducted to determine efficacy of the intervention. ASP comprises an infectious diseases physician and pharmacist. Interventions consist of prospective audit and feedback regarding antibiotic choices, microbiology and duration of therapy. Bivariate analysis of baseline characteristics and comorbid conditions were performed between the timeframes. Least squares regression was used to analyze length of stay, time to intravenous (IV) to oral (PO) conversions and duration of antibiotics adjusted for significant factors from the bivariate analysis. A multivariate logistic regression, adjusted for significant factors for readmission, was utilized to determine odds of 30-day readmission between time periods.

Results. There were 86 patients in the pre-ASP period and 88 patients in the ASP period. A total of 130 recommendations were implemented during the intervention time period. Patients in the ASP group were more likely to have sputum cultures (p = 0.02) and blood cultures (p = 0.03) obtained when compared to pre-ASP. Antibiotic therapy was more frequently deescalated during ASP (43% versus 65%, p = 0.004). Mean length of stay decreased from 8.1 days to 6.6 days (p = 0.02), total duration of antibiotic therapy decreased from 12 days to 8.5 days (p < 0.0001) and time to IV to PO antibiotic conversions decreased from 5.3 days to 3.9 days (p = 0.0003). The odds ratio of 30-day readmission pre-ASP was 2.78 while the odds ratio during the intervention timeframe was 0.36 (p = 0.05).

Conclusion. This antimicrobial stewardship program was effective at increasing culture frequency, deescalating therapy and converting patients from IV to PO therapy. The ASP was able to provide interventions that resulted in shorter durations of therapy, decreased length of stay and lower rates of readmission within 30 days.

Disclosures. All authors: No reported disclosures.

Author notes