Impact of a pharmacist‐driven azithromycin de‐escalation initiative for community‐acquired pneumonia

Abstract

AbstractBackgroundCommunity‐acquired pneumonia (CAP) is a commonly encountered infection and cause of hospitalization. Discontinuation of atypical antibiotic coverage when atypical bacteria are the unlikely cause of CAP represents a potential antimicrobial stewardship opportunity.Study ObjectiveTo compare azithromycin duration, hospital length of stay (LOS), 30‐day all‐cause or pneumonia readmission, and in‐hospital mortality before and after implementation of a pharmacist‐driven azithromycin de‐escalation initiative in the setting of negative laboratory data for atypical bacteria in immunocompetent, nonintensive care unit (non‐ICU) patients treated for CAP.DesignSingle‐center, quasi‐experimental study.SettingA 472‐bed academic medical center in Syracuse, NY.PatientsPatients were included if they were ≥18 years old, diagnosed with CAP, and had a negative Legionella pneumophila urinary antigen and negative Biofire FilmArray Respiratory Panel for Mycoplasma pneumoniae and Chlamydia pneumoniae. Patients were excluded if they were immunocompromised, admitted to an ICU during hospitalization, prescribed azithromycin for an alternate indication, or had evidence of atypical bacteria.Measurements and Main ResultsA total of 983 patients received an azithromycin‐containing regimen for CAP during the study period with 458 and 525 patients in preintervention and postintervention cohorts, respectively. After exclusion criteria were applied, 90 and 100 patients were included in the preintervention and postintervention cohorts, respectively. Demographic and clinical characteristics were mostly similar between cohorts. A statistically significant reduction in azithromycin duration (2 days [interquartile range (IQR) 1‐2.75] vs 5 days [IQR 3‐6], P < .001) and hospital LOS (3 days [IQR 2‐5] vs 5 days [IQR 3‐8.25], P < .001) were observed in the postintervention cohort compared with the preintervention cohort. No statistically significant difference was identified for 30‐day all‐cause 30‐day readmission (15.6% vs 13.0%, P = .614), 30‐day readmission secondary to pneumonia (4.44% vs 2.0%, P = .926), or in‐hospital mortality (1.1% vs 1.0%, P = 1.000) between cohorts.ConclusionImplementation of a pharmacist‐driven azithromycin de‐escalation initiative for immunocompetent, non‐ICU patients with CAP was associated with a decrease in azithromycin duration and hospital LOS without increasing 30‐day all‐cause or pneumonia readmission, or in‐hospital mortality.