89 - construction of an Electronic Algorithm to Efficiently Target Antimicrobial Stewardship Efforts for Adults Hospitalized with Community-acquired Pneumonia

Background: Although antibiotic stewardship programs (ASPs) have had success in curtailing inappropriate antibiotic use, they remain time- and labor-intensive. To expand the reach of ASPs, approaches to more efficiently target ASP efforts are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in patients hospitalized with community-acquired pneumonia (CAP).      

Methods: Within the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 300 subjects (150-HUP, 150-PPMC). Inappropriateness of antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established hospital and IDSA guidelines.

Results: Of 300 subjects, median age was 60, 53% were female, and median hospital stay was 4.25 days. Of the 300 subjects, 237 (79%) were admitted to general medicine, hospitalist, family medicine, or geriatrics services. On chart review, 295 (98%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 263 (89%). Of these 263 subjects, 222 (84%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.

Conclusion: An electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate for patients hospitalized for CAP. This algorithm could be used to efficiently target ASP initiatives. The impact of interventions based on this algorithm should be tested in future studies.Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration

Presenting Author(s)

• 

  Ebbing Lautenbach, MD, MPH, MSCE

  Professor of Medicine and Epidemiology
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• KH

  Keith W. Hamilton, MD

  Associate Professor Of Clinical Medicine
  Hospital of the University of Pennsylvania
  Philadelphia, PA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• RG

  Robert Grundmeier, MD

  Associate Professor
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MN

  Melinda M. Neuhauser, PharmD, MPH

  Pharmacist and Acute Care Lead
  Centers for Disease Control and Prevention
  Chicago, Illinois

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Lauri Hicks, DO

  Director, Office of Antibiotic Stewardship
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AJ

  Anne Jaskowiak, MS

  Project Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LC

  Leigh Cressman, MA

  Biostatistician
  University of Pennsylvania School of Medicine
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• TJ

  Tony James, BA

  Research Assistant
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• JO

  Jacqueline Omorogbe, MBE

  Research Coordinator
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NF

  Nicole Frager, MPH

  Project Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MM

  Muida Menon, MS

  Research Coordinator
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• EK

  Ellen Kratz, BA

  Project Manager
  Children's Hospital of Philadelphia
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Jeffrey Gerber, MD, PhD

  Associate Professor of Pediatrics
  Children's Hospital of Philadelphia
  Philadelphia, PA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.