Using Probability of Community-Acquired Pneumonia to Tailor Antimicrobials Among Inpatients: A Pragmatic, Randomized...

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Trials

Background:

• Respiratory infections are a leading cause of unnecessary antibiotic prescriptions in hospitalized patients.
• Current diagnostic tests (procalcitonin, respiratory virus testing) alone do not consistently guide antibiotic decisions.
• A need exists for improved strategies to optimize antibiotic use in respiratory infections.

Purpose of the Study:

• To evaluate the effectiveness of antimicrobial stewardship-guided interpretation of diagnostic tests for suspected respiratory infections.
• To determine if this intervention can reduce antibiotic use in hospitalized adults.

Main Methods:

• A pragmatic, randomized controlled trial was conducted at two hospitals.
• The intervention group received stewardship-guided interpretation of procalcitonin and respiratory virus tests via electronic health record templates.
• The primary outcome measured was in-hospital antibiotic days of therapy.

Main Results:

• The intervention group experienced a significant reduction in antibiotic days of therapy (4.1 fewer days; P = .006).
• Discontinuation of antibiotics within 5 days occurred in 76% of the intervention group versus 49% in the usual care group (P = .004).
• No significant differences were observed in length of stay or 30-day readmission rates.

Conclusions:

• Antimicrobial stewardship-guided interpretation of laboratory tests for viral infection can safely decrease unnecessary antibiotic use.
• This proof-of-concept study demonstrates a viable strategy for optimizing antibiotic prescribing in community-acquired respiratory illness.
• Further research may validate these findings in broader clinical settings.