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Yang D, Cressman L, Hamilton KW, Dutcher L. Electronic health record-based identification of inpatients receiving antibiotic treatment for community-acquired pneumonia. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e53. [PMID: 38655025 PMCID: PMC11036418 DOI: 10.1017/ash.2024.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
We conducted a retrospective study to assess performance of provider-selected antibiotic indication (PSI) in identifying hospitalized adults with community-acquired pneumonia. PSI showed moderate sensitivity (64.4%) and high specificity (96.3%). PSI has potential utility for targeted real-time antibiotic stewardship interventions, though future research should investigate methods to improve sensitivity.
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Affiliation(s)
- David Yang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Leigh Cressman
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Keith W. Hamilton
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Severe Adenoviral Pneumonia in an Immunocompetent Host with Persistent Fevers Treated with Multiple Empiric Antibiotics for Presumed Bacterial Co-Infection: An Antibiotic Stewardship Perspective on De-Escalation Derailed. J Clin Med 2017; 6:jcm6040042. [PMID: 28375168 PMCID: PMC5406774 DOI: 10.3390/jcm6040042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/24/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
We present a case of severe adenoviral pneumonia in a 20-year-old immunocompetent host with persistently high fevers. The patient was needlessly given multiple empiric antibiotics for non-existent bacterial co-infection. This case has important antibiotic stewardship lessons for practitioners in approaching fevers in the ICU.
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Evaluation of Management of Uncomplicated Community-Acquired Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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[Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia]. BIOMEDICA 2017; 37:104-110. [PMID: 28527254 DOI: 10.7705/biomedica.v37i2.3025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/10/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION One of the strategies for the rational use of antibiotics is the use of the score for community-acquired pneumonia (CAP Score). This instrument clinically evaluates patients with community-acquired pneumonia, thereby facilitating decision making regarding the early and safe withdrawal of antibiotics. OBJECTIVE To generate a translation and cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire in Spanish. MATERIALS AND METHODS Authorization for cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire was obtained; the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the European Organisation for Research and Treatment of Cancer (EORTC) were carried out through the following stages: forward translation, reconciliation, backward translation, harmonization, obtaining a provisional questionnaire, and applying the questionnaire in a pilot test. The pilot test was conducted at a second-level public hospital in Bogotá after the study was approved by the ethics and research institutional boards. RESULTS The changes suggested by the forward translators were applied. There were no discrepancies between the backward and forward translations, consequently, no revisions were necessary. Five items had modifications based on suggestions made by eleven patients hospitalized with a diagnosis of community-acquired pneumonia during the pilot test. CONCLUSIONS A Spanish version of the Community-Acquired Pneumonia (CAP) Score was crossculturally adapted and is now available.
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Madaras-Kelly KJ, Burk M, Caplinger C, Bohan JG, Neuhauser MM, Goetz MB, Zhang R, Cunningham FE. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. J Hosp Med 2016; 11:832-839. [PMID: 27527659 DOI: 10.1002/jhm.2648] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/23/2016] [Accepted: 06/28/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia. DESIGN Retrospective medication utilization evaluation. SETTING Thirty Veterans Affairs medical centers. PATIENTS Inpatients discharged with a diagnosis of pneumonia. MEASUREMENTS A manual review of electronic medical records of inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was conducted. Appropriate CAP therapy duration was defined as at least 5 days, and up to 3 additional days beginning the first day the patient achieved clinical stability criteria; the appropriate HCAP therapy duration was defined as 8 days. The duration of antimicrobial therapy for intravenous (IV) and oral (PO) inpatient administration, PO therapy dispensed upon discharge, Clostridium difficile infection (CDI), hospital readmission, and death rates were measured. RESULTS Of 3881 pneumonia admissions, 1739 met inclusion criteria (CAP [n = 1195]; HCAP [n = 544]). Overall, 13.9% of patients (CAP [6.9%], HCAP [29.0%]) received therapy duration consistent with guideline recommendations. The median (interquartile range) days of therapy were 4 days (3-6 days), 1 day (0-3 days), and 6 days (4-8 days) for inpatient IV, inpatient PO, and outpatient PO antimicrobials, respectively. CDI was rare but more common in patients who received therapy duration consistent with guidelines. Therapy duration was not associated with the readmission or mortality rate. CONCLUSIONS Antimicrobials were commonly prescribed for a longer duration than guidelines recommend. The majority of excessive therapy was completed upon discharge, identifying the need for strategies to curtail unnecessary use postdischarge. Journal of Hospital Medicine 2015;11:832-839. © 2015 Society of Hospital Medicine.
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Affiliation(s)
- Karl J Madaras-Kelly
- Pharmacy Service, Veterans Affairs Medical Center and Department of Pharmacy Practice, College of Pharmacy, Idaho State University, Meridian, Idaho
| | - Muriel Burk
- Center for Medication Safety, Hines VA, Hines, Illinois
- VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois
| | | | | | | | - Matthew Bidwell Goetz
- Infectious Diseases Section, VA Greater Los Angeles Health Care System and David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California
| | | | - Francesca E Cunningham
- Center for Medication Safety, Hines VA, Hines, Illinois
- VA Pharmacy Benefits Management Services, Hines VA, Hines, Illinois
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Clinical Diagnosis, Viral PCR, and Antibiotic Utilization in Community-Acquired Pneumonia. Am J Ther 2016; 23:e766-72. [DOI: 10.1097/mjt.0000000000000018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rendon A, Rendon-Ramirez EJ, Rosas-Taraco AG. Relevant Cytokines in the Management of Community-Acquired Pneumonia. Curr Infect Dis Rep 2016; 18:10. [PMID: 26874956 PMCID: PMC7088528 DOI: 10.1007/s11908-016-0516-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Community-acquired pneumonia (CAP) is the leading cause of infectious death in the world. Immune dysregulation during acute lung infection plays a role in lung injury and the systemic inflammatory response. Cytokines seem to be major players in severe lung infection cases. Here, we present a review of published papers in the last 3 years regarding this topic. The cytokine response during pneumonia is different in bacterial vs viral infections; some of these cytokines correlate with clinical severity scales such as CURB65 or SOFA. Treatment focused in the cytokine environment is an interesting area that could impact the prognosis of CAP. Some of the agents that have been studied as co-adjuvant therapy are corticosteroids, macrolides, and linezolid, but anyone of those have shown a clear or proven efficacy or have been recommended as a part of the standard of care for CAP. More studies designed to define the role of immunomodulatory agents, such as co-adjuvant therapy in pneumonia, are needed.
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Affiliation(s)
- Adrian Rendon
- School of Medicine and University Hospital, CIPTIR (Centro de investigación, prevención y tratamiento de infecciones respiratorias), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Erick J Rendon-Ramirez
- School of Medicine and University Hospital, Internal Medicine Department, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrian G Rosas-Taraco
- Department of Immunology Monterrey, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Høgli JU, Garcia BH, Skjold F, Skogen V, Småbrekke L. An audit and feedback intervention study increased adherence to antibiotic prescribing guidelines at a Norwegian hospital. BMC Infect Dis 2016; 16:96. [PMID: 26920549 PMCID: PMC4769530 DOI: 10.1186/s12879-016-1426-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/10/2016] [Indexed: 02/01/2023] Open
Abstract
Background Appropriate antibiotic prescribing is associated with favourable levels of antimicrobial resistance (AMR) and clinical outcomes. Most intervention studies on antibiotic prescribing originate from settings with high level of AMR. In a Norwegian hospital setting with low level of AMR, the literature on interventions for promoting guideline-recommended antibiotic prescribing in hospital is scarce and requested. Preliminary studies have shown improvement potentials regarding antibiotic prescribing according to guidelines. We aimed to promote appropriate antibiotic prescribing in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) at a respiratory medicine department in a Norwegian University hospital. Our specific objectives were to increase prescribing of appropriate empirical antibiotics, reduce high-dose benzylpenicillin and reduce total treatment duration. Methods We performed an audit and feedback intervention study, combined with distribution of a recently published pocket version of the national clinical practice guideline. We included patients discharged with CAP or AECOPD and prescribed antibiotics during hospital stay, and excluded those presenting with aspiration, nosocomial infection and co-infections. The pre- and post-intervention period was 9 and 6 months, respectively. Feedback was provided orally to the department physicians at an internal-educational meeting. To explore the effect of the intervention on appropriate empirical antibiotics and mean total treatment duration we applied before-after analysis (Student’s t-test) and interrupted time series (ITS). We used Pearson’s χ2 to compare dose changes. Results In the pre-and post-intervention period we included 253 and 155 patients, respectively. Following the intervention, overall mean prescribing of appropriate empirical antibiotics increased from 61.7 to 83.8 % (P < 0.001), overall mean total treatment duration decreased from 11.2 to 10.4 days (P = 0.015), and prescribing of high-dose benzylpenicillin decreased from 48.8 to 38.6 % (P = 0.125). With ITS we found that six months post-intervention, the effect on appropriate empirical antibiotic prescribing had increased and sustained, while the effect on treatment duration was at pre-intervention level. Conclusion The combination of audit and feedback plus distribution of a pocket version of guideline recommendations led to a substantial increase in prescribing of appropriate empirical antibiotics, which is important due to favourable effect on AMR and clinical outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1426-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- June Utnes Høgli
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
| | - Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
| | - Frode Skjold
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
| | - Vegard Skogen
- Department of Infectious Diseases, Division of Internal Medicine, University Hospital of North Norway, N - 9038, Tromsø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
| | - Lars Småbrekke
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, N - 9037, Tromsø, Norway.
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Madaras-Kelly K, Jones M, Remington R, Caplinger C, Huttner B, Samore M. Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data. BMC Infect Dis 2015; 15:197. [PMID: 25927970 PMCID: PMC4418054 DOI: 10.1186/s12879-015-0933-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparison of antimicrobial de-escalation rates between healthcare settings is problematic. To objectively and electronically measure de-escalation a method based upon the spectrum of antimicrobial regimens administered (i.e., spectrum score) was developed. METHODS A Delphi process was used to develop applicable concepts. Spectrum scores were created for 27 antimicrobials based upon susceptibility for 19 organisms. National VA susceptibility data was used to estimate microbial spectrum. Susceptibility estimates were converted to ordinal scores, and values for organisms with multi-drug resistance potential were weighted more heavily. Organism scores were summed to create antibiotic-specific spectrum scores and extended mathematically to score multi-antimicrobial regimens. Vignettes were created from antimicrobial regimens administered to 300 patients hospitalized with pneumonia. Daily spectrum scores were calculated for each case. Hospitalization day 4 scores were subtracted from day 2 scores (i.e., spectrum score ∆). A positive spectrum score ∆ defined de-escalation. Experts ranked each pneumonia case on a 7-point Likert scale (Likert >4 indicated de-escalation). Spectrum score ∆s were compared to expert review. Findings were used to identify score deficiencies. Next, 40 pairs of cases were modified to include antimicrobial administration routes. Each pair contained almost similar regimens; however, one contained oral (PO) the other only intravenous (IV) antimicrobials on day 4 of therapy. Experts reviewed cases as described. Spectrum score ∆ credits to account for PO conversion were derived from the mean paired differences in Likert Score. De-escalation status was evaluated in 100 vignettes containing antimicrobial route by different experts and compared to the modified method. RESULTS Initial sensitivity and specificity of the spectrum score ∆ to detect expert classified de-escalation events was 86.3 and 96.0%, respectively. In paired cases, the mean (± SD) Likert score was 5.0 (1.5) and 4.6 (1.5) for PO and IV (P = 0.002), respectively. To improve de-escalation event detection, two credits were added to spectrum score ∆s based upon the percentage of antimicrobials administered PO on day 4. The final method, exhibited sensitivity and specificity to detect expert classified de-escalation events of 96.2 and 93.6%, respectively. CONCLUSIONS The final spectrum score method exhibited excellent agreement with expert judgments of de-escalation events in pneumonia.
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Affiliation(s)
- Karl Madaras-Kelly
- Pharmacy Service, Boise Veterans Affairs Medical Center and College of Pharmacy, Idaho State University, T111, 500 W Fort Street, Boise, 83702, USA.
| | - Makoto Jones
- IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology Health Care System and Division of Epidemiology, University of Utah, 500 Foothill Drive, Salt Lake City, 84148, UT, USA.
| | - Richard Remington
- Research Service, Boise Veterans Affairs Medical Center and Quantified Inc, T111, 500 W Fort Street, Boise, 83702, USA.
| | - Christina Caplinger
- Research Fellow, Pharmacy Service, Boise Veterans Affairs Medical Center, T111, 500 W Fort Street, Boise, 83702, USA.
| | - Benedikt Huttner
- Infection Control Programme & Division of Infectious Diseases, Faculty of Medicine, Geneva University Hospitals, Rue Gabrielle Perret- Gentil 4, Geneva, 1211, Switzerland.
| | - Matthew Samore
- IDEAS Center, VA Salt Lake City Health Care System and Division of Epidemiology, University of Utah, 500 Foothill Drive, Salt Lake City, UT, 84148, USA.
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Pakhale S, Mulpuru S, Verheij TJM, Kochen MM, Rohde GGU, Bjerre LM. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev 2014; 2014:CD002109. [PMID: 25300166 PMCID: PMC7078574 DOI: 10.1002/14651858.cd002109.pub4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is the third leading cause of death worldwide and the first leading cause of death in low-income countries. Community-acquired pneumonia (CAP) is a common condition that causes a significant disease burden for the community, particularly in children younger than five years, the elderly and immunocompromised people. Antibiotics are the standard treatment for CAP. However, increasing antibiotic use is associated with the development of bacterial resistance and side effects for the patient. Several studies have been published regarding optimal antibiotic treatment for CAP but many of these data address treatments in hospitalised patients. This is an update of our 2009 Cochrane Review and addresses antibiotic therapies for CAP in outpatient settings. OBJECTIVES To compare the efficacy and safety of different antibiotic treatments for CAP in participants older than 12 years treated in outpatient settings with respect to clinical, radiological and bacteriological outcomes. SEARCH METHODS We searched CENTRAL (2014, Issue 1), MEDLINE (January 1966 to March week 3, 2014), EMBASE (January 1974 to March 2014), CINAHL (2009 to March 2014), Web of Science (2009 to March 2014) and LILACS (2009 to March 2014). SELECTION CRITERIA We looked for randomised controlled trials (RCTs), fully published in peer-reviewed journals, of antibiotics versus placebo as well as antibiotics versus another antibiotic for the treatment of CAP in outpatient settings in participants older than 12 years of age. However, we did not find any studies of antibiotics versus placebo. Therefore, this review includes RCTs of one or more antibiotics, which report the diagnostic criteria and describe the clinical outcomes considered for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors (LMB, TJMV) independently assessed study reports in the first publication. In the 2009 update, LMB performed study selection, which was checked by TJMV and MMK. In this 2014 update, two review authors (SP, SM) independently performed and checked study selection. We contacted trial authors to resolve any ambiguities in the study reports. We compiled and analysed the data. We resolved differences between review authors by discussion and consensus. MAIN RESULTS We included 11 RCTs in this review update (3352 participants older than 12 years with a diagnosis of CAP); 10 RCTs assessed nine antibiotic pairs (3321 participants) and one RCT assessed four antibiotics (31 participants) in people with CAP. The study quality was generally good, with some differences in the extent of the reporting. A variety of clinical, bacteriological and adverse events were reported. Overall, there was no significant difference in the efficacy of the various antibiotics. Studies evaluating clarithromycin and amoxicillin provided only descriptive data regarding the primary outcome. Though the majority of adverse events were similar between all antibiotics, nemonoxacin demonstrated higher gastrointestinal and nervous system adverse events when compared to levofloxacin, while cethromycin demonstrated significantly more nervous system side effects, especially dysgeusia, when compared to clarithromycin. Similarly, high-dose amoxicillin (1 g three times a day) was associated with higher incidence of gastritis and diarrhoea compared to clarithromycin, azithromycin and levofloxacin. AUTHORS' CONCLUSIONS Available evidence from recent RCTs is insufficient to make new evidence-based recommendations for the choice of antibiotic to be used for the treatment of CAP in outpatient settings. Pooling of study data was limited by the very low number of studies assessing the same antibiotic pairs. Individual study results do not reveal significant differences in efficacy between various antibiotics and antibiotic groups. However, two studies did find significantly more adverse events with use of cethromycin as compared to clarithromycin and nemonoxacin when compared to levofloxacin. Multi-drug comparisons using similar administration schedules are needed to provide the evidence necessary for practice recommendations. Further studies focusing on diagnosis, management, cost-effectiveness and misuse of antibiotics in CAP and LRTI are warranted in high-, middle- and low-income countries.
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Affiliation(s)
- Smita Pakhale
- The Ottawa Hospital, Ottawa Hospital Research Institute and the University of OttawaDepartment of Medicine501 Smyth RoadOttawaONCanadaK1H 8L6
| | - Sunita Mulpuru
- The Ottawa Hospital, General CampusDivision of Respirology501 Smyth RoadBox 211OttawaONCanadaK1H 8L6
| | - Theo JM Verheij
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA
| | - Michael M Kochen
- University of Göttingen Medical SchoolDepartment of General Practice/Family MedicineLudwigstrasse 37FreiburgGermanyD‐79104
| | - Gernot GU Rohde
- Maastricht University Medical CenterDepartment of Respiratory MedicinePO box 5800MaastrichtNetherlands6202 AZ
- CAPNETZ STIFTUNGHannoverGermany
| | - Lise M Bjerre
- University of OttawaDepartment of Family Medicine, Bruyere Research Institute43 Bruyere StRoom 369YOttawaONCanadaK1N 5C8
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Richey EA, Dudley L, Liu SK. Quality improvement in hospital management of community-acquired pneumonia: focus on new strategies and current challenges. Curr Infect Dis Rep 2014; 16:395. [PMID: 24474070 DOI: 10.1007/s11908-014-0395-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Community-acquired pneumonia is a common reason for hospitalization and leads to significant morbidity and mortality. There are published evidence-based guidelines for the diagnosis, treatment, and management of community-acquired pneumonia. Many countries, including the US, have developed national, publically reported quality measures related to the treatment of community-acquired pneumonia. This review highlights recent published innovations aimed at improving the quality of care for patients hospitalized for community-acquired pneumonia. Interventions include standardized protocols and pathways, education and feedback from antimicrobial stewardship teams, and automated pharmacy technology. The importance of multidisciplinary collaboration and multidimensional interventions are discussed. Insight into local context and institutional support are essential to understanding the implementation of improvement efforts and these factors should be reported in future publications related to quality improvement.
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Aliberti S, Kaye KS. The changing microbiologic epidemiology of community-acquired pneumonia. Postgrad Med 2014; 125:31-42. [PMID: 24200759 DOI: 10.3810/pgm.2013.11.2710] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease in the United States and the incidence continues to grow as the aging population increases. Overall, in-hospital patient mortality rates have been reported to be as high as 18%. Management of patients with CAP has been challenged by the evolution of resistant pathogens (particularly Streptococcus pneumoniae and Staphylococcus aureus) that have reduced susceptibility to recommended standard antimicrobial agents. Streptococcus pneumoniae continues to be the most frequently identified pathogen in CAP and recently, S. aureus has been found to be the second most often identified pathogen. Data from the SENTRY Antimicrobial Surveillance Program has shown declining susceptibility of pneumococci to penicillin, amoxicillin/clavulanate, and ceftriaxone from 1998 through 2011. In the Assessing Worldwide Resistance Evaluation (AWARE) surveillance program, > 50% of all S. aureus isolates from patient bloodstream infections, skin and skin structure infections, and pneumonia were methicillin-resistant. Stratifying risk factors to identify patients at risk for community-acquired multidrug-resistant pathogens should be considered when selecting therapy. Differences in microbiology and outcomes have been noted in patients presenting from the community with recent exposure to the health care system (eg, nursing home residents, patients with a recent hospital admission). These patients are at an increased risk of an infection caused by a multidrug-resistant pathogen. Understanding a patient's risk for drug-resistant pathogens will allow the physician to choose an appropriate empiric treatment regimen to optimize clinical outcomes.
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Affiliation(s)
- Stefano Aliberti
- Department of Health Science, University of Milan Bicocca, AO San Gerardo, Milan, Italy.
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