Abstract
Abstract Background In accordance with the American Thoracic Society (ATS) guidelines for community-acquired pneumonia (CAP), ceftriaxone plus a macrolide is commonly used as first-line for inpatient treatment of non-severe CAP(Metlay, 2019). In a community hospital, a CAP protocol was implemented to grant pharmacists the capability to discontinue antibiotics, including ceftriaxone, after 5 days of treatment in hospitalized patients that have reached clinical stability. On the other hand, extended treatment duration of ceftriaxone can lead to increased resistance, Clostridium difficile infections, adverse effects and cost (Guo 2017, Thomas 2002). The objective of this study is to compare patient outcomes between patients using ≤5 days (recommended duration) and >5 days (extended duration) of ceftriaxone. Methods This study is a retrospective chart review in a community hospital, from Nov 1, 2022 to April 30, 2023. Adult patients treated with ceftriaxone for ≥ 3 days for CAP were included. Patients treated for non-pulmonary infections and/or co-infections were excluded. The primary outcome of this study is 30-day mortality; secondary outcomes include length of stay, and Clostridium difficile infection within 90 days. Outcomes were analyzed with Chi-square/Fischer’s exact test, normality test, student t-test, and Mann-Whitney U test using Prism Version 10. IRB Number: 2024-167 AHGL Results The 30-day all-cause mortality was 7.1% for the ≤5 days group (N = 379) and 7.8% for the >5 days group (N = 166) was not statistically significant (p = 0.77). Length of stay median with interquartile range (IQR) was 6 (IQR 4-9) for the ≤5 days group and 8 (IQR 6-11) for the >5 days group (p < 0.01). The Clostridium difficile infection prevalence of 0.5% in the ≤5 days group and 0% in the >5 days group was too low to make any relevant analysis. Conclusion This study comparing patient outcomes between ≤5 days and >5 days durations of ceftriaxone for community-acquired pneumonia (CAP) revealed no significant difference in 30-day all-cause mortality rates but a significantly shorter hospital stays in ≤5 days group, which suggests that shorter ceftriaxone durations as per protocol can potentially optimize patient care by reducing hospital stays without compromising mortality outcome. Disclosures All Authors: No reported disclosures
Published Version
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