Appropriateness of Antibiotic Therapy During the First 72 Hours of a Hospital Visit in Patients with Community-Acquired Pneumonia

Abstract

Specific Aims: The objectives of this project were to determine the time to appropriate antibiotic therapy for community-acquired pneumonia, evaluate the appropriateness of antibiotic changes within a 72 hour period, and to determine the rate of re-admissions for pneumonia. Methods: A retrospective chart review of patients admitted to an academic medical center in March 2012 with a diagnosis of pneumonia was performed. Subjects under the age of 18 years or who were not treated for infectious pneumonia were excluded. Relevant data were extracted from the subjects’ electronic charts and recorded onto a data collection form. Data collected included antibiotics given within the first 72 hours and times of administration, laboratory results, culture and susceptibility results, radiology results, testing for coccidiodomycosis, reason for readmissions within 30 days if applicable, and demographic information. A descriptive analysis of these data was performed. Main Results: A total 100 subjects were included in the final data analysis with a mean age of 64 years. During the first 48 hours, patients were prescribed vancomycin (52%), azithromycin (48%), ceftriaxone (41%), moxifloxacin (30%), piperacillin-tazobactam (25%), meropenem (22%), and other antibiotics (26%). The mean (+SD) number of antibiotics prescribed within the first 24 hours was 2.5 (1.1). Either azithromycin, azithromycin plus ceftriaxone, or moxifloxacin only were prescibed in 21% of subjects within the first 24 hours. Within the first day, combinations of broadspectrum antibiotics (meropenem, piperacillin-tazobactam, cefepime) or a combination of ceftrixone plus either meropenem or piperacillin-tazobactam were prescribed in 6% and 12% of subjects, respectively. The appropriateness of empiric therapy and antibiotic changes is currently in progress. A total of 53% of subjects were discharged with prescriptions for extended course oral or intravenous antibiotics. While 27% of subjects were readmitted within a 30-day period, 9% of subjects were readmitted with either a diagnosis of pneumonia or related respiratory condition. One subject was readmitted within 30 days with Clostridium difficile associated diarrhea. During the initial admission, coccidioidomycosis testing was performed in 38% of subjects. Conclusion: A variety of combinations of antibiotic agents were prescribed to subjects diagnosed with community-acquired pneumonia. Changes to antibiotic therapies were frequent and often without explanation. Readmission rates for a respiratory related illness within 30-days was approximately 9% and less than 40% of subjects were tested for coccidioidomycosis.