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Evaluation of Management of Uncomplicated Community-Acquired Pneumonia: A Retrospective Assessment

Walsh, Thomas L. MD; DiSilvio, Briana E. MD; Speredelozzi, Daniel MD; Hammer, Crystal D. MD; Hu, Kurt MD; Abdulmassih, Rasha MD; Makadia, Jina T. MD; Sandhu, Rikinder MD; Naddour, Mouhib MD; Vishwanathan, Swati MD; Chan-Tompkins, Noreen H. PharmD, BCPS-AQ ID; Trienski, Tamara L. PharmD; Moffa, Matthew A. DO; Bremmer, Derek N. PharmD, BCPS

Infectious Diseases in Clinical Practice: March 2017 - Volume 25 - Issue 2 - p 71–75
doi: 10.1097/IPC.0000000000000468
Original Articles

Background: Community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality in the United States. Studies have shown that interventions such as shorter antibiotic therapy and early intravenous (IV) to oral conversion can be safely performed. We evaluated areas of improvement at our institutions that could help optimize patient management while reducing collateral damage associated with excessive antibiotic usage.

Methods: In this retrospective analysis, all patients aged 18 years and older with a primary International Classification of Diseases, Ninth Revision code for CAP admitted from March 1, 2014, to October 31, 2014, were analyzed. The primary outcome was duration of antibiotic therapy for uncomplicated CAP (appropriate treatment duration defined as 7 days or less). Secondary objectives included duration of IV antibiotic therapy, duration of inpatient length of stay, and 30-day readmission rate related to CAP.

Results: Of the 141 patients evaluated, 98 (69.5%) met inclusion criteria. The mean total duration of antibiotic therapy was 10.1 ± 3.4 days, and the mean duration of IV therapy was 4.9 ± 3.3 days. Only 26.5% of patients received 7 days or less of antibiotic therapy, whereas 38.8% received greater than 10 days of therapy.

Conclusions: Our findings are concerning given the available data demonstrating that short-course therapy with 5 to 7 days is clinically as effective as long-course therapy and associated with fewer adverse events. The management of uncomplicated CAP represents a significant opportunity for antimicrobial stewardship intervention.

Despite current evidence demonstrating that 5 to 7 days of antibiotic therapy is adequate for clinical cure of uncomplicated community acquired pneumonia (CAP), the majority of patients receive inappropriately excessive duration of therapy. Additionally, inappropriate broad-spectrum antibiotic selection is utilized with regularity for uncomplicated CAP. While evidence supports early intravenous to oral conversion is safe and effective, the majority of patients receive prolonged intravenous therapy.

From the *Division of Infectious Disease, Allegheny General Hospital; †Division of Infectious Disease, The Western Pennsylvania Hospital; ‡Department of Medicine, Allegheny General Hospital; §Department of Medicine, The Western Pennsylvania Hospital; ∥Department of Pharmacy, Allegheny General Hospital; and ¶Department of Pharmacy, The Western Pennsylvania Hospital, Pittsburgh, PA.

Correspondence to: Thomas L. Walsh, MD, Division of Infectious Disease Allegheny General Hospital, 320 East North Avenue, 4th Floor East Wing, Suite 406 Pittsburgh, PA 15136. E-mail: twalsh@wpahs.org.

The authors have no funding or conflicts of interest to disclose.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.