Long-term impact of DRIP score on antibiotic stewardship in patients with community acquired pneumonia

Abstract

<b>Introduction:</b> Broad spectrum antibiotics are overused in the treatment of community acquired pneumonia (CAP). We have previously reported a validated risk score for drug-resistant pathogens (DRIP) whose implementation within electronic clinical decision support reduced empiric, inappropriate, broad-spectrum antibiotic use in CAP. <b>Objectives:</b> Evaluate whether DRIP implementation produced a durable reduction in the rate of broad-spectrum antibiotic prescription. <b>Methods:</b> We identified patients with CAP admitted to one of four hospitals in 3 cohorts: 1) pre-implementation (2011-2012), 2) shortly after DRIP implementation (2014-2015) and 3) long-term post-implementation (2017-2019). Antibiotics were classified as broad-spectrum if their spectrum included MRSA or P. Aeruginosa and were not appropriate based on CAP guidelines. <b>Results:</b> There were 3750 patients, 86% white, 51% women, median age 65. The cohorts had 1377, 1218 and 1155 patients, respectively. The rate of broad-spectrum antibiotic use in each cohort was 30.0%, 24.7% and 22.4%. Implementation of an electronic clinical decision support tool for empiric initial antibiotic selection in CAP resulted in a sustained decrease in extended-spectrum antibiotic use from prior to implementation through two periods afterward, p&lt;0.001. <b>Conclusions:</b> Embedding a validated, automated risk score for predicting drug resistant pathogens in electronic clinical decision support resulted in a significant, durable reduction in broad-spectrum antibiotic use for CAP. This result highlights the critical role automated interventions can play in guiding important processes of care.