Impact of Antimicrobial Stewardship Program (ASP) on Patients With Pneumonia

Abstract

PURPOSE: Pneumonia is one of the most common infectious diagnoses encountered in clinical practice and one of the leading causes of death. Adherence to antibiotic treatment guidelines is inconsistent and the erroneous diagnosis of pneumonia and misuse of antibiotics is common. We aim to evaluate if ASP can improve outcomes for hospitalized patients with pneumonia. METHOD(S): We conducted a retrospective review of the ASP database of all patients with pneumonia, and our ASP had recommended changes in antibiotic regimen from 1st September 2011 to 28th February 2013. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. RESULT(S): A total of 5296 patients were audited from 1st September 2011 to 28th February 2013. Of which 891 interventions were made to deescalate antibiotics based on cultures, narrowing of empirical choice of antibiotics, discontinuation of antibiotics and conversion of intravenous to oral antibiotics. Out of 251 patients in the rejected group, 45 (18%) died due to infection while 52 patients (8%) of 640 patients in the accepted group died due to infection in the accepted group. Mortality due to infection was statistically significantly lower in the accepted group when compared to rejected group (p<0.01). Out of the 733 patients who survived, 13 patients in the rejected group (n=185) were readmitted due to infection while 55 patients in the accepted group (n=548). Readmission due to infection was not statistically significant between the 2 groups (p=0.24). Two patients had 14-day re-infection in accepted group (n=29) while no patients in the rejected group had a 14 day re-infection. Mean duration of hospitalization was 10+/-21 days in the accepted group and 14+/-20 days in the rejected group. Duration of hospitalization was statistically significant shorter in the accepted vs rejected group (p=0.14). CONCLUSION(S): ASP has been demonstrated to be safe in reducing mortality and hospitalization stay in patients with pneumonia.