An antibiotic stewardship initiative focused on community-acquired bacterial pneumonia (CABP) in outpatient clinics and urgent care centers: a 2023–2024 community health system experience
Abstract Objective: This before–after study aimed to evaluate whether an order-set intervention would improve CABP-guideline concordance among outpatients. Setting: This study included adult patients presenting to outpatient clinics (n = 92) and urgent care centers (n = 39) within a community-ba...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25101009/type/journal_article |
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| Summary: | Abstract
Objective:
This before–after study aimed to evaluate whether an order-set intervention would improve CABP-guideline concordance among outpatients.
Setting:
This study included adult patients presenting to outpatient clinics (n = 92) and urgent care centers (n = 39) within a community-based health system without a formal outpatient antibiotic stewardship program (ASP).
Intervention:
The intervention consisted of an antibiotic order-set and awareness campaign. Patient encounters were identified via CABP ICD-10 codes and IDSA-relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia) were extracted from the electronic health record. Primary outcome was to describe the proportion of patients receiving concordant therapy per IDSA guideline and local antibiogram in a pre- (May 2023 – April 2024) and post-intervention period (May 2024 – December 2024).
Results:
Baseline and intervention antibiotic concordance rate was 33.3% (1,467/4,401 encounters) and 28.0% (1,388/4,954 encounters), respectively. Among patients with no comorbidity, monotherapy prescriptions (concordant and discordant) decreased post-intervention and were replaced by higher levels of combination therapy (15% increase), albeit all discordant due to lack of comorbidities. Among patients with comorbidities, combination antibiotics increased by 12% post-intervention, driven by concordant prescriptions including amoxicillin/clavulanate plus azithromycin while the most frequently prescribed discordant combination was amoxicillin plus azithromycin. Trends were similar in primary care and urgent care centers.
Conclusions:
A stewardship intervention, including an order-set and awareness campaign improved the selection of combination therapy for appropriate patients but did not improve overall guideline concordance. For health systems without a dedicated outpatient ASP, these data will help bolster stewardship efforts towards more effective strategies.
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| ISSN: | 2732-494X |