Department of Pharmacy, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-5425, USA.
Clin Infect Dis. 2012 Jun;54(11):1581-7. doi: 10.1093/cid/cis242. Epub 2012 Apr 10.
Initial management of community-acquired pneumonia (CAP) has been a Centers for Medicare and Medicaid Services performance measure for a decade. We hypothesized that an intervention directed at management of CAP that assesses areas not covered by the performance measures-treatment duration and antimicrobial selection after additional microbiology data are available--would further improve CAP management.
We performed a single-center, prospective study to compare management of adult inpatients with presumed CAP before (from 1 January 2008 through 31 March 2008) and after (from 1 February 2010 through 10 May 2010) an intervention consisting of education and prospective feedback to teams regarding antibiotic choice and duration. The primary outcome measure was duration of antibiotic therapy in the 2 periods.
There were 62 patients in the preintervention period and 65 patients in the intervention period. The duration of antibiotic therapy decreased from a median of 10 to 7 days (P < .001), with 148 fewer days of antibiotic therapy. The median lengths of stay were similar in the 2 groups (4 vs 5 days). A causative pathogen was identified less frequently during the intervention period (14% vs 34%); however, antibiotics were more frequently narrowed or modified on the basis of susceptibility results during the intervention period (67% vs 19%). Fewer patients received duplicate therapy within 24 hours in the intervention period (90% vs 55%).
The duration of therapy for CAP was excessive at our institution and was decreased with a stewardship intervention. Confirmatory studies at other institutions are needed; efforts to assess and reduce duration of therapy for CAP should be strongly considered.
社区获得性肺炎（CAP）的初始治疗已成为医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）十年来的一项绩效衡量标准。我们假设，针对 CAP 管理的干预措施，评估了绩效衡量标准未涵盖的领域-在获得更多微生物学数据后治疗持续时间和抗菌药物选择-将进一步改善 CAP 管理。
我们进行了一项单中心前瞻性研究，比较了在干预措施（包括针对抗生素选择和持续时间的团队教育和前瞻性反馈）之前（2008 年 1 月 1 日至 3 月 31 日）和之后（2010 年 2 月 1 日至 5 月 10 日）对疑似 CAP 的成年住院患者的管理情况。主要观察指标为两个时期抗生素治疗的持续时间。
干预前组有 62 例患者，干预组有 65 例患者。抗生素治疗的持续时间从中位数 10 天缩短至 7 天（P <.001），减少了 148 天的抗生素治疗。两组的中位住院时间相似（4 天与 5 天）。在干预期间，确定的病原体较少（14%与 34%）；然而，在干预期间，基于药敏结果更频繁地缩小或修改抗生素（67%与 19%）。在干预期间，更少的患者在 24 小时内接受重复治疗（90%与 55%）。
我们机构的 CAP 治疗时间过长，通过管理干预措施得到了缩短。需要在其他机构进行确认性研究；应强烈考虑评估和减少 CAP 治疗时间的努力。
