Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul 10;5(7):ofy162.
doi: 10.1093/ofid/ofy162. eCollection 2018 Jul.

Microbiology Comment Nudge Improves Pneumonia Prescribing

Mary A Musgrove  1 , Rachel M Kenney  1 , Ronald E Kendall  2 , Michael Peters  1 , Robert Tibbetts  3 , Linoj Samuel  3 , Susan L Davis  1   4
Affiliations

Microbiology Comment Nudge Improves Pneumonia Prescribing

Mary A Musgrove et al. Open Forum Infect Dis. .

Abstract

Background: Systematic and behavioral interventions are needed to improve antibiotic use for common conditions like pneumonia.

Methods: Single pretest, post-test quasi-experiment in a 4-hospital health system in metropolitan Detroit, Michigan. Hospitalized patients treated with anti-methicillin-resistant Staphylococcus aureus and antipseudomonal antibiotics for respiratory infections from August 1, 2015, through January 31, 2016, and August 1, 2016, through January 31, 2017, were eligible for inclusion. Beginning in May 2016, respiratory cultures with no dominant organism growth and no Pseudomonas sp. or Staphylococcus aureus were reported by the clinical microbiology laboratory as "commensal respiratory flora only: No S. aureus/MRSA [methicillin-resistant Staphylococcus aureus] or P. [Pseudomonas] aeruginosa." Before intervention, these were reported as "commensal respiratory flora." The primary end point was de-escalation or discontinuation of anti-methicillin-resistant Staphylococcus aureus or antipseudomonal therapy. Secondary clinical and safety outcomes included nephrotoxicity and in-hospital, all-cause mortality.

Results: Two hundred ten patients were included in the study. De-escalation/discontinuation was more commonly performed in the intervention group (39% vs 73%, P < .001). After adjusting for APACHE II and Charlson Comorbidity Index, the intervention comment was associated with a 5.5-fold increased odds of de-escalation (adjusted odds ratio, 5.5; 95% confidence interval, 2.8-10.7). Acute kidney injury was reduced in the intervention phase (31% vs 14%, P = .003). No difference in all-cause mortality was detected between the groups (30% vs 18%, P = .052).

Conclusion: A simple, behavioral nudge in microbiology reporting increased de-escalation and discontinuation of unnecessary broad-spectrum antibiotics. This highlights the importance of clear, persuasive communication of diagnostic testing in improving antibiotic prescribing behaviors.

Keywords: antibiotic use; antimicrobial stewardship; microbiology; pneumonia; vancomycin.

PubMed Disclaimer

References

    1. Magill SS, Edwards JR, Beldavs ZG, et al. . Prevalence of antimicrobial use in US acute care hospitals. May-September 2011. JAMA 2014; 312:1438–46. - PMC - PubMed
    1. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005; 171:388–416. - PubMed
    1. Wunderink RG. Community-acquired pneumonia versus healthcare-associated pneumonia. The returning pendulum. Am J Respir Crit Care Med 2013; 188:896–8. - PubMed
    1. Chalmers JD, Taylor JK, Singanayagam A, et al. . Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis 2011; 53:107–13. - PubMed
    1. Madaras-Kelly K, Jones M, Remington R, et al. . Antimicrobial de-escalation of treatment for healthcare-associated pneumonia within the Veterans Healthcare Administration. J Antimicrob Chemother 2016; 71:539–46. - PMC - PubMed

LinkOut - more resources