Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study

Sara Tomczyk, Seema Jain, Anna M. Bramley, Wesley H. Self, Evan J. Anderson, Chris Trabue, D. Mark Courtney, Carlos G. Grijalva, Grant W. Waterer, Kathryn M. Edwards, Richard G. Wunderink, Lauri A. Hicks

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish (US)
Article numberofx088
JournalOpen Forum Infectious Diseases
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Pneumonia
Anti-Bacterial Agents
Guidelines
beta-Lactams
Fluoroquinolones
Macrolides
Vancomycin
Delivery of Health Care
Communicable Diseases
Outpatients
Thorax
Inpatients
Epidemiology
Logistic Models

Keywords

  • Antibiotics
  • Community-acquired pneumonia

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Tomczyk, S., Jain, S., Bramley, A. M., Self, W. H., Anderson, E. J., Trabue, C., ... Hicks, L. A. (2017). Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study. Open Forum Infectious Diseases, 4(2), [ofx088]. https://doi.org/10.1093/ofid/ofx088

Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study. / Tomczyk, Sara; Jain, Seema; Bramley, Anna M.; Self, Wesley H.; Anderson, Evan J.; Trabue, Chris; Courtney, D. Mark; Grijalva, Carlos G.; Waterer, Grant W.; Edwards, Kathryn M.; Wunderink, Richard G.; Hicks, Lauri A.

In: Open Forum Infectious Diseases, Vol. 4, No. 2, ofx088, 01.03.2017.

Research output: Contribution to journalArticle

Tomczyk, S, Jain, S, Bramley, AM, Self, WH, Anderson, EJ, Trabue, C, Courtney, DM, Grijalva, CG, Waterer, GW, Edwards, KM, Wunderink, RG & Hicks, LA 2017, 'Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study', Open Forum Infectious Diseases, vol. 4, no. 2, ofx088. https://doi.org/10.1093/ofid/ofx088
Tomczyk, Sara ; Jain, Seema ; Bramley, Anna M. ; Self, Wesley H. ; Anderson, Evan J. ; Trabue, Chris ; Courtney, D. Mark ; Grijalva, Carlos G. ; Waterer, Grant W. ; Edwards, Kathryn M. ; Wunderink, Richard G. ; Hicks, Lauri A. / Antibiotic prescribing for adults hospitalized in the etiology of pneumonia in the community study. In: Open Forum Infectious Diseases. 2017 ; Vol. 4, No. 2.
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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.",
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AU - Anderson, Evan J.

AU - Trabue, Chris

AU - Courtney, D. Mark

AU - Grijalva, Carlos G.

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