2025 Southeastern Residency Conference

SERC Abstract: Limit of 600 words or less (not including title and authors).
Title: Impact of Comprehensive Education on Antibiotic Duration of Therapy for Community-Acquired Pneumonia in a Community Hospital
Authors: Keaton Prebble, Layla Marefat
Objective: Determine if pharmacist-led comprehensive education clinical pharmacists and hospitalists impacted the duration of therapy for community-acquired pneumonia.
Self-Assessment Question: The 2019 IDSA CAP guidelines recommend that if a patient is clinically improving, they may complete a total duration of therapy of:
Background: In 2019, the Infectious Disease Society of America (IDSA) released updated guidelines for the treatment of community-acquired pneumonia (CAP). These guidelines recommend a new preferred duration of therapy of no less than a total of five days if the patient has achieved clinical stability. Patients who receive extended antibiotic duration of therapy are at an increased risk of antibiotic resistance development and potential for adverse events. Many patients with CAP are likely to be discharged from an inpatient stay prior to completion of antibiotic therapy, and providers who prescribe antibiotics at discharge can, as a result, increase the duration of therapy when not indicated. This presents an opportunity for clinical pharmacists to intervene in both patients being discharged and those still admitted that it would be reasonable to receive only five days of therapy. This quality improvement project will determine whether comprehensive education to pharmacists and providers impacts the total duration of therapy of antibiotics for patients treated for CAP.
Methods: The study is an IRB-approved, retrospective cohort study. Patients who were hospitalized for at least 48 hours, had a diagnosis of pneumonia within 48 hours of inpatient admission, received antibiotic treatment indicated for pneumonia, and were at least 18 years old were included. Patients who were critically ill, had a palliative care consult during admission, had concomitant bacteremia, had received antibiotics for pneumonia for a separate admission in the last 14 days, or were immunocompromised were excluded.
Education was provided to clinical pharmacists during scheduled monthly meetings for a six-month period starting in August 2024. Hospitalists were educated in a separate meeting prior to post-intervention data collection. Data was collected from February 1, 2024, to July 31, 2024, and September 1, 2024, to February 28, 2025, via Slicer Dicer for the pre- and post-intervention groups respectively. The education consisted of both verbal and written materials that follow both the IDSA CAP guidelines and Baptist Health Lexington policies and procedures.
The primary endpoint was to evaluate the difference in mean antibiotic duration of therapy for patients with CAP in the pre- and post-intervention groups. The secondary endpoints were the difference in median duration of therapy for patients with an antibiotic switch, mean duration of therapy for patients with an outpatient prescription, initial procalcitonin, MRSA nares PCR ordered, sputum cultures collected.
Results: There were 116 and 145 patients from the pre- and post-intervention groups respectively. Overall mean duration of therapy decreased by 0.9 days after the intervention (7.3 ± 2.7 and 6.4 ± 2 days respectively in the pre- and post-intervention groups p = 0.005). Median duration of therapy decreased by one day for patients who had any antibiotic switch during admission after the intervention (7 days [IQR 6-10] and 6 days [IQR 5-8] in the pre- and post-intervention groups respectively p < 0.001). The mean duration of therapy for patients with an antibiotic prescription at discharge decreased by 1.5 days after the intervention (8.8 ± 3 and 7.3 ± 2.3 days respectively in the pre- and post- intervention groups p < 0.01). MRSA nares PCR was ordered for 66 and 76 patients in the pre- and post- intervention groups. Sputum cultures were collected for 36 and 39 patients respectively in the pre- and post- intervention groups.
Conclusions: The pharmacist-led education showed a statistically significant difference between the primary and secondary endpoints between the pre- and post-intervention periods.