2197. Ceftriaxone Monotherapy vs. Ceftriaxone Plus Azithromycin for the Treatment of Community-Acquired Pneumonia in Hospitalized, Non-ICU Patients

Abstract

Session: 244. Bacterial Respiratory Infections Saturday, October 5, 2019: 12:15 PM Background. Vancomycin is a commonly utilized empiric therapy for patients with hospital-acquired and healthcare-associated pneumonia (HAP and HCAP). De-escalation is encouraged in the guidelines but not commonly performed in the absence of culture data. Studies have shown that in certain low-risk patients, vancomycin may not be necessary. A clinical criterion document was implemented in 2018 at CHI Memorial to facilitate rapid de-escalation of vancomycin. This study aims to assess the impact of early discontinuation of vancomycin in patients with HAP or HCAP and no respiratory culture. Methods. A retrospective cohort analysis was conducted in adult inpatients who presented from September to December 2017 and 2018 with HAP or HCAP, no respiratory culture within 72 hours, and at most one risk factor for MRSA. Patients who did not meet criteria for de-escalation, were receiving antibiotics for an extrapulmo-nary infection, or had a pathogen identified from blood or urinary antigen tests were excluded. The primary endpoint was vancomycin days of therapy pre-vs. post-intervention. Secondary endpoints include vancomycin restart , subsequent respiratory culture growing MRSA, intensive care unit (ICU) and total length of stay, total days of antibiotic therapy, total days of alternate anti-MRSA therapy and in-hospital mortality in de-escalated vs. non-de-escalated patients. Results. A total of 66 patient were included; 25 in the pre-and 41 in the post-period. The median age was 83 in the pre-and 68 in the post-period, with 20% of patients being initiated in the ICU and one patient with HAP in each group. There was no difference in median days of vancomycin therapy in the pre-vs. post-intervention period (4 days [3-5] vs. 4 days [3-5]) P = 0.583. There were 37 patients not de-escalated and 29 patients rapidly de-escalated. Total days of inpatient antibiotic therapy was significantly lower in the de-escalated group (7 days [5-9] vs. 5 days [4-7]) P = 0.037. No other significant differences were noted (Table 2). Conclusion. There was no difference in vancomycin days of therapy after the implementation of this pharmacist-led initiative. However, discontinuing vancomycin within 72 hours was safe in patients with HCAP and was associated with decreased days of inpatient antibiotic therapy.