Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation
| Autor: | Karl Madaras-Kelly, Muriel Burk, Jefferson G Bohan, Rongping Zhang, Christina Caplinger, Matthew Bidwell Goetz, Francesca E. Cunningham, Melinda M. Neuhauser |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Leadership and Management 030106 microbiology Assessment and Diagnosis 03 medical and health sciences 0302 clinical medicine Interquartile range Medicine 030212 general & internal medicine Intensive care medicine Care Planning Veterans Affairs business.industry Health Policy Mortality rate Medical record Retrospective cohort study General Medicine Guideline medicine.disease Hospital medicine Pneumonia Emergency medicine Fundamentals and skills business |
| Zdroj: | Journal of Hospital Medicine. 11:832-839 |
| ISSN: | 1553-5592 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text