Impact of Combination Antibiogram and Related Education on Inpatient Fluoroquinolone Prescribing Patterns for Patients With Health Care-Associated Pneumonia

Abstract

Background: Previous studies have shown that development of a unit-specific combination antibiogram improves optimal selection of empiric therapy for Gram-negative infections, yet no published data exist regarding the role of the combination antibiogram as an antimicrobial stewardship program tool for disease-specific prescribing.

Objective: To evaluate the utility of a combination antibiogram to guide antibiotic prescribing for patients with health care-associated pneumonia (HCAP).

Methods: This was a retrospective preprovider and postprovider education intervention study aimed to evaluate fluoroquinolone (FQ) use in patients with HCAP. Data were collected retrospectively to evaluate antibiotic prescribing patterns and patient outcomes.

Results: A total of 87 patients were eligible for study inclusion. The primary end point, FQ days of therapy (DOT) was decreased by 2.3 days (P < 0.001). The secondary end point included FQ DOT per 1000 patient-days in patients with discharge diagnosis-related group of pneumonia and was decreased by 83.5 days (P = 0.08); double coverage reduced by 13% postintervention (P = 0.22); mean days of double coverage decreased by 2.1 days (P < 0.001), and length of stay was shortened by 2.1 days (P = 0.22). Clinical success was achieved more often in the postintervention group (90% vs 98%, P = 0.18) when compared with the preintervention group. No difference was found in microbiological outcomes in the subset of microbiologically evaluable patients (P = 0.57).

Conclusion: Facility-specific combination antibiograms may be used to inform antibiotic prescribing in HCAP patients.

Keywords: antimicrobial stewardship; combination antibiogram; double coverage; fluoroquinolone; health care–associated pneumonia.