Simulated Adoption of 2019 Community-Acquired Pneumonia Guidelines Across 114 Veterans Affairs Medical Centers: Estimated Impact on Culturing and Antibiotic Selection in Hospitalized Patients.

Autor:	Christensen MA; Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA., Nevers M; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA., Ying J; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA., Haroldsen C; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA., Stevens V; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA., Jones MM; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA., Yarbrough PM; Department of Internal Medicine, Veterans Affairs Salt Lake City Health Care System and University of Utah, Salt Lake City, Utah, USA., Goetz MB; Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Restrepo MI; Division of Pulmonary and Critical Care, South Texas Veterans Health Care System and UT Health San Antonio, San Antonio, Texas, USA., Madaras-Kelly K; Pharmacy Service, Veterans Affairs Boise Idaho and Idaho State University, Boise, Idaho, USA., Samore MH; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA., Jones BE; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Pulmonary and Critical Care, University of Utah, Salt Lake City, Utah, USA.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2021 Jan 29; Vol. 72 (Suppl 1), pp. S59-S67.
DOI:	10.1093/cid/ciaa1604
Abstrakt:	Background: The 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) revised recommendations for culturing and empiric broad-spectrum antibiotics. We simulated guideline adoption in Veterans Affairs (VA) inpatients. Methods: For all VA acute hospitalizations for CAP from 2006-2016 nationwide, we compared observed with guideline-expected proportions of hospitalizations with initial blood and respiratory cultures obtained, empiric antibiotic therapy with activity against methicillin-resistant Staphylococcus aureus (anti-MRSA) or Pseudomonas aeruginosa (antipseudomonal), empiric "overcoverage" (receipt of anti-MRSA/antipseudomonal therapy without eventual detection of MRSA/P. aeruginosa on culture), and empiric "undercoverage" (lack of anti-MRSA/antipseudomonal therapy with eventual detection on culture). Results: Of 115 036 CAP hospitalizations over 11 years, 17 877 (16%) were admitted to an intensive care unit (ICU). Guideline adoption would slightly increase respiratory culture (30% to 36%) and decrease blood culture proportions (93% to 36%) in hospital wards and increase both respiratory (40% to 100%) and blood (95% to 100%) cultures in ICUs. Adoption would decrease empiric selection of anti-MRSA (ward: 27% to 1%; ICU: 61% to 8%) and antipseudomonal (ward: 25% to 1%; ICU: 54% to 9%) therapies. This would correspond to greatly decreased MRSA overcoverage (ward: 27% to 1%; ICU: 56% to 8%), slightly increased MRSA undercoverage (ward: 0.6% to 1.3%; ICU: 0.5% to 3.3%), with similar findings for P. aeruginosa. For all comparisons, P < .001. Conclusions: Adoption of the 2019 CAP guidelines in this population would substantially change culturing and empiric antibiotic selection practices, with a decrease in overcoverage and slight increase in undercoverage for MRSA and P. aeruginosa. (Published by Oxford University Press for the Infectious Diseases Society of America 2021.)
Databáze:	MEDLINE
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