scholarly journals Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to analyze antibiotic stewardship interventions

2017 ◽  
Author(s):  
Valentijn A. Schweitzer ◽  
Maarten van Smeden ◽  
Douwe F. Postma ◽  
Jan Jelrik Oosterheert ◽  
Marc J.M. Bonten ◽  
...  
Keyword(s):  
Relative Risk ◽  
Clinical Outcome ◽  
Antibiotic Stewardship ◽  
Sample Size Calculation ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Beta Lactam ◽  
Risk Of Mortality ◽  
Novel Method ◽  
Severe Community Acquired Pneumonia

ABSTRACTOBJECTIVESThe Response Adjusted for Days of Antibiotic Risk (RADAR)-statistic was proposed to improve efficiency of antibiotic stewardship trials. We studied the behavior of RADAR in a non-inferiority trial in which a beta-lactam monotherapy strategy (BL, n=656) was non-inferior to fluoroquinolone monotherapy (FQL, n=888) for moderately-severe community-acquired pneumonia (CAP) patients.METHODSPatients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the BL group had a more favorable ranking than the FQL group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the BL group and performed the RADAR and non-inferiority analysis.RESULTSThe RADAR of the BL-group compared to the FQL group was 60.3% (95% confidence interval 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favor of BL. Sample sizes for RADAR were 250 and 580 patients per study arm using five or eight clinical outcome categories, respectively, reflecting 38% and 89% of the original non-inferiority sample size calculation. With simulated mortality rates, loss of non-inferiority of the BL-group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the BL-group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively.CONCLUSIONSRADAR favored BL over FQL therapy for CAP. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes.

scholarly journals Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Sara Tomczyk ◽  
Seema Jain ◽  
Anna M Bramley ◽  
Wesley H Self ◽  
Evan J Anderson ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Community Study ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
First Line ◽  
Factors Associated ◽  
Admission Ward ◽  
Healthcare Associated ◽  
To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

scholarly journals Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock

2019 ◽  
Vol 8 (5) ◽  
pp. 754 ◽  
Author(s):  
Estel Güell ◽  
Marta Martín-Fernandez ◽  
Mari C. De la Torre ◽  
Elisabet Palomera ◽  
Mateu Serra ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Form ◽  
Community Acquired Pneumonia ◽  
Immunological Failure ◽  
Risk Of Mortality ◽  
Clinical Presentations ◽  
Severe Community Acquired Pneumonia ◽  
Time Of Admission ◽  
Single Blood Sample

Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.

Optimal Antibiotic Use in Severe Community-Acquired Pneumonia

Sepsis ◽  
2008 ◽  
pp. 85-95
Author(s):  
Alejandro Rodríguez ◽  
Mónica Magret ◽  
Jordi Rello
Keyword(s):  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Severe Community Acquired Pneumonia

scholarly journals 1991. Implementation of Rapid Turnaround PCR Bacterial/Viral Panel Testing in Community-acquired Pneumonia Decreases LOS, Antibiotic Cost, Antibiotic Charges, and Antibiotic Use

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S668-S668
Author(s):  
Rebecca D Shadowen ◽  
Akash Doshi ◽  
Rene Ndzi ◽  
Faraaz Kazimuddin
Keyword(s):  
Logistic Regression ◽  
Antibiotic Stewardship ◽  
Intervention Group ◽  
Binary Logistic Regression ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
T Test ◽  
Control Group ◽  
Panel Testing ◽  
Antibiotic Cost

Abstract Background Community-acquired pneumonia (CAP) is a significant infection contributing to hospitalization, morbidity, mortality, intensive care, antibiotic use, and healthcare costs. Antibiotic stewardship aims to improve appropriate antibiotic use which addresses these same issues. Accurate, confirmed diagnosis upon presentation of CAP patients using Respiratory Bacteria/Viral (RBVP) Polymerase Chain Reaction (PCR) panels can significantly impact outcomes in the CAP patient population. Methods In this cross-sectional study, commercially available RBVP PCR panels were used. Comparison of CAP patient populations was done before PCR use (2014–2015 control group) and after implementation (2016–2017 intervention group) using a provider choice intervention following education and order availability. Providers were educated via multiple means with lectures, individual meetings, online brief presentation, and group discussions. A nursing computer-based learning module was also developed and required to be completed. Independent sample t-test and binary logistic regression were used to analyze data. Results Out of total 2,523 observations in the study, 1,994 (79.03%) were in the control group and 529 (20.96%) were in the intervention group. An independent sample t-test showed significant differences in the mean of length of stay (LOS) (P = 0.04, 95% CI: 8.67–9.36), total antibiotic cost (TAC) (P = 0.000, 95% CI: 486.61–550.45), antibiotic charges (ACH) (P = 0.048, 95% CI: 1,815.79–2,009.75), and antibiotic defined daily doses (DDD) (P = 0.039, 95% CI: 6.84–7.42). Binary logistic regression results revealed statistical significance in LOS (P = 0.01, 95% CI: 0.9251–0.9902) and TAC (P = 0.000, 95% CI: 0.9989–0.9994). Actual savings per patient were LOS 0.88 days, TAC $202.73, ACH $240.23, and DDD 0.77. Conclusion The use of RBVP PCR panel testing in CAP patients decreases antibiotic use, LOS, and cost of care. This correlated with antibiotic de-escalation providing a significant contribution to antibiotic stewardship. PCR panel testing with rapid turnaround is widely available and cost effective. Disclosures All authors: No reported disclosures.

Sustained Impact of an Antibiotic Stewardship Intervention for Community-Acquired Pneumonia

2016 ◽  
Vol 37 (10) ◽  
pp. 1243-1246 ◽  
Author(s):  
David X. Li ◽  
Marcela A. Ferrada ◽  
Edina Avdic ◽  
Pranita D. Tamma ◽  
Sara E. Cosgrove
Keyword(s):  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Infect Control Hosp ◽  
Short Term ◽  
Antibiotic Overuse ◽  
Additional Intervention

Antibiotic stewardship interventions targeting community-acquired pneumonia have been successful in reducing antibiotic overuse in the short term, but the sustainability of their effects has not been investigated. We report that improvements in antibiotic use due to a syndrome-focused intervention for community-acquired pneumonia were sustained 3 years later without additional intervention.Infect Control Hosp Epidemiol 2016;1–4

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