Institutional members access full text with Ovid®

Prospective Evaluation of a Novel Treatment Algorithm for Health Care-Associated Pneumonia

Fazylov, Roman PharmD; Peyko, Vincent PharmD, BCPS; Burney, Sibte MD; Cohen, Henry MS, PharmD, FCCM, BCPP, GCP

Infectious Diseases in Clinical Practice: March 2017 - Volume 25 - Issue 2 - p 82–87
doi: 10.1097/IPC.0000000000000480
Original Articles

Background: The current health care–associated pneumonia (HCAP) model may be too broad, leading to inappropriate use of broad-spectrum antibiotics. As a result, therapeutic algorithms, such as what Maruyama et al validated, have been developed for a more specific therapy. Our study aims to validate this algorithm in our patient population.

Methods: This is a single-center, prospective, cohort study, with a historical control cohort. The prospective cohort followed an outlined algorithm to determine empiric therapy as compared with a historical cohort, which followed the standard of care. Prospective cohort patients were categorized as low versus high risk based on the algorithm and started on empiric community-acquired pneumonia (CAP) or HCAP regimens, respectively. Primary objectives included length of stay and initial empiric failure. Secondary objectives included patients treated with CAP versus HCAP regimens, intravenous to oral conversion time, antibiotic duration, and incidence of acute kidney injury.

Results: There was no difference in the primary outcomes of length of stay and initial empiric regimen. Secondary outcomes were significant for elevated frequency of empiric CAP regimens compared with HCAP regimens and shorter antibiotic duration.

Conclusions: The current definition of HCAP may be too expansive leading to the overuse of broad-spectrum antibiotics. Risk stratification based on the presence of multidrug-resistant risk factors and severity of illness may prove to be a useful assessment tool in determining targeted empiric therapy and limit the propagation of bacterial resistance.

Healthcare-associated pneumonia (HCAP) resides between the community and hospital setting and is a common and complicated disease state. Yet the current HCAP treatment model may be too broad, leading to inappropriate use of broad-spectrum antibiotics. As a result, certain treatment algorithms have been developed for more specifi c therapy. This study aims to validate an evidence-based algorithm in our patient population, to provide better insight for the medical community in choosing community versus hospital-associated treatment regimens.

From the *Touro College of Pharmacy, Touro College, New York; †Kingsbrook Jewish Medical Center, Brooklyn, NY; and ‡Emergency Department, Mercy Health, Boardman, OH.

Correspondence to: Vincent Peyko, PharmD, BCPS, Emergency Department, Mercy Health, 8401 Market St, Boardman, OH 44512. E-mail: Vjpeyko@mercy.com.

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

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