Treatment Heterogeneity in Pseudomonas aeruginosa Pneumonia
Aisling R Caffrey1,2,3,4, Haley J Appaneal1,2,3,4, J Xin Liao1,3
1Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI 02908, USA.
Abstract:
We have previously identified substantial antibiotic treatment heterogeneity, even among organism-specific and site-specific infections with treatment guidelines. Therefore, we sought to quantify the extent of treatment heterogeneity among patients hospitalized with P. aeruginosa pneumonia in the national Veterans Affairs Healthcare System from Jan-2015 to Apr-2018. Daily antibiotic exposures were mapped from three days prior to culture collection until discharge. Heterogeneity was defined as unique patterns of antibiotic treatment (drug and duration) not shared by any other patient. Our study included 5300 patients, of whom 87.5% had unique patterns of antibiotic drug and duration. Among patients receiving any initial antibiotic/s with a change to at least one anti-pseudomonal antibiotic (n = 3530, 66.6%) heterogeneity was 97.2%, while heterogeneity was 91.5% in those changing from any initial antibiotic/s to only anti-pseudomonal antibiotics (n = 576, 10.9%). When assessing heterogeneity of anti-pseudomonal antibiotic classes, irrespective of other antibiotic/s received (n = 4542, 85.7%), 50.5% had unique patterns of antibiotic class and duration, with median time to first change of three days, and a median of two changes. Real-world evidence is needed to inform the development of treatment pathways and antibiotic stewardship initiatives based on clinical outcome data, which is currently lacking in the presence of such treatment heterogeneity.
Insights
Antibiotic treatment for Pseudomonas aeruginosa pneumonia shows significant variation. Most patients (87.5%) received unique drug and duration combinations, highlighting the need for standardized treatment pathways.
Area of Science:
- Infectious Diseases
- Pharmacology
- Health Services Research
Background:
- Antibiotic treatment guidelines exist, yet significant heterogeneity in prescribing practices has been observed.
- Pseudomonas aeruginosa pneumonia is a serious hospital-acquired infection requiring effective antibiotic therapy.
Purpose of the Study:
- To quantify the extent of antibiotic treatment heterogeneity in patients hospitalized with P. aeruginosa pneumonia.
- To analyze patterns of antibiotic drug selection and duration in a large patient cohort.
Main Methods:
- Retrospective analysis of electronic health records from the Veterans Affairs Healthcare System (Jan 2015 - Apr 2018).
- Mapping daily antibiotic exposures from three days prior to culture collection until discharge.
- Defining heterogeneity as unique patterns of antibiotic treatment (drug and duration) not shared by other patients.
Main Results:
- A total of 5300 patients were included; 87.5% exhibited unique antibiotic drug and duration patterns.
- Among patients with a switch to anti-pseudomonal antibiotics, heterogeneity reached 97.2%.
- When considering anti-pseudomonal antibiotic classes, 50.5% of patients had unique patterns, with a median of two changes.
Conclusions:
- Substantial real-world antibiotic treatment heterogeneity exists for P. aeruginosa pneumonia.
- The findings underscore the need for clinical outcome data to develop evidence-based treatment pathways and antibiotic stewardship programs.
- Addressing this heterogeneity is crucial for optimizing patient care and combating antimicrobial resistance.
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