Category: Antimicrobial Stewardship: Outcomes Assessment (clinical and economic)

Poster Session: Antimicrobial Stewardship: Outcomes Assessment (clinical and economic)

66 - Impact of a Pharmacist-Driven Azithromycin De-escalation Protocol for Community-Acquired Pneumonia

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Co-Author(s)

PS

Pegah Shakeraneh

PGY2 Infectious Diseases Pharmacy Resident
State University of New York Upstate University Hospital
Syracuse, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JS

Jeffrey Steele

Clinical Pharmacy Specialist, Infectious Diseases
State University of New York Upstate University Hospital
Syracuse, NY
Disclosure: Paratek Pharmaceuticals (Advisor or Review Panel member)
RS

Robert Seabury

Clinical Pharmacist
SUNY Upstate University Hospital
Syracuse, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
ST

Stephen J. Thomas

Division Chief, Infectious Diseases and Professor of Medicine and Microbiology & Immunology
Upstate Medical University
Syracuse, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KP

Kristopher M. Paolino

Assistant Professor
State University of New York Upstate Medical University
Syracuse, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Christopher R. Miller

Pharmacy Student
Wayne State University
Detroit, MI
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LP

Luke A. Probst

Executive Director of Pharmacy Services
State University of New York Upstate University Hospital
Syracuse, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Presenting Author(s)

Wesley D. Kufel

Clinical Associate Professor
Binghamton University School of Pharmacy Sciences
Binghamton, New York
Disclosure: Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

Background: Ceftriaxone and azithromycin are common empiric antibiotics for community-acquired pneumonia (CAP). Despite low suspicion for atypical infection, azithromycin is often continued for a full course. Negative laboratory data for atypical bacteria may assist with azithromycin de-escalation. Thus, a pharmacist-driven azithromycin de-escalation protocol was implemented for immunocompetent, non-intensive care unit (ICU) patients treated for CAP. The primary outcome was to compare azithromycin duration before and after protocol implementation. Secondary outcomes included hospital length of stay (LOS) and all-cause 30-day readmission.

Methods: This was a single-center, quasi-experimental study of hospitalized, non-ICU patients treated with azithromycin and a beta-lactam for CAP. The pre- and post-intervention cohorts were from 07/01/2018–04/30/2019 and 07/01/2019–04/30/2020, respectively. Patients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative nasopharyngeal swab PCR for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU, prescribed azithromycin for an alternative indication, or had evidence of atypical bacteria.

Results: After exclusion criteria were applied, 90 and 100 patients were included in the pre- and post-intervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. This initiative was associated with a statistically significant decrease in azithromycin duration (2 days (IQR 1-2.75) vs. 5 days (IQR 3-6), p < 0.001) and hospital LOS (3 days (IQR 2-5) vs. 5 days (IQR 3-8.25), p < 0.001). No statistically significant difference was observed for all-cause 30-day readmission (14 days (15.6%) vs 13 days (13.0%), p=0.614).

Conclusion: Implementation of a pharmacist-driven azithromycin de-escalation protocol for CAP was associated with reduced azithromycin duration and hospital LOS, but not all-cause 30-day readmission.