2025/01/01 by Tomefa E. Asempa, Tyler Ackley, Kristin E. Linder +3 · 1 voice
Immunology and Microbiology · Medicine · #Antibiotic Use and Resistance #Nosocomial Infections in ICU #Pneumonia and Respiratory Infections
paper · pdf · doi:10.1017/ash.2025.10100
openalex publication_date 2025/01/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
Objective: This before-after study aimed to evaluate whether an order-set intervention would improve CABP-guideline concordance among outpatients. Setting: = 39) within a community-based health system without a formal outpatient antibiotic stewardship program (ASP). Intervention: The intervention consisted of an antibiotic order-set and awareness campaign. Patient encounters were identified via CABP ICD-10 codes and IDSA-relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia) were extracted from the electronic health record. Primary outcome was to describe the proportion of patients receiving concordant therapy per IDSA guideline and local antibiogram in a pre- (May 2023 - April 2024) and post-intervention period (May 2024 - December 2024). Results: Baseline and intervention antibiotic concordance rate was 33.3% (1,467/4,401 encounters) and 28.0% (1,388/4,954 encounters), respectively. Among patients with no comorbidity, monotherapy prescriptions (concordant and discordant) decreased post-intervention and were replaced by higher levels of combination therapy (15% increase), albeit all discordant due to lack of comorbidities. Among patients with comorbidities, combination antibiotics increased by 12% post-intervention, driven by concordant prescriptions including amoxicillin/clavulanate plus azithromycin while the most frequently prescribed discordant combination was amoxicillin plus azithromycin. Trends were similar in primary care and urgent care centers. Conclusions: A stewardship intervention, including an order-set and awareness campaign improved the selection of combination therapy for appropriate patients but did not improve overall guideline concordance. For health systems without a dedicated outpatient ASP, these data will help bolster stewardship efforts towards more effective strategies.