1810. Trends in the Length of Antibiotic Therapy Among Hospitalized Adults with Uncomplicated Community-Acquired Pneumonia, 2013-2020. (15th December 2022)

• Record Type: Journal Article
• Authors: Kazakova, Sophia V; Natalie, McCarthy; Baggs, James; Attell, Brandon; Kabbani, Sarah; Yi, Sarah H; Neuhauser, Melinda M; Hatfield, Kelly M; Reddy, Sujan; Hicks, Lauri A
• Is Part Of: Open forum infectious diseases. Volume 9:(2022)Supplement 2
• Publication Date: 2022-12-15
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac492.1440
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The 2014 United States National Strategy aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions by 2020. The Hospital Core Elements of Antibiotic Stewardship highlight opportunities to improve treatment of common infections, including optimizing length of therapy (LOT) for community-acquired pneumonia (CAP). A minimum of 5 days of antibiotic therapy for patients with uncomplicated CAP is recommended, with > 7 days, or > 3 days after clinical improvement, rarely necessary. In this study, we evaluated annual trends in LOT from 2013-2020. Methods: We conducted a retrospective cohort study using IBM MarketScan® database to evaluate LOT annual trends among adults 18-64 years in the United States hospitalized with uncomplicated CAP from 2013-2020. We included patients with a primary diagnosis of bacterial or unspecified pneumonia using International Classification of Diseases 9th and 10th revision codes, length of stay (LOS) of 2-10 days, discharged home with self-care, and not re-hospitalized in the 3 days following discharge. Discharge home was used as a surrogate for clinical improvement. We obtained inpatient LOS and post-discharge LOT data from MarketScan. We estimated annual inpatient LOT based on LOS from the Premier Healthcare Database (PHD). Total LOT was calculated by summing predicted inpatient LOT (from PHD) and actual post-discharge LOT (from MarketScan). Proportion of total LOT > 7 days and post-discharge LOT > 3 days were considered indicators of likely excessive LOT. Results: There were 44, 976 uncomplicated CAP hospitalizations among patients 18–64 years in MarketScan, 2013-2020. Patients had a median age of 54 years, median LOS of 3 days, were more likely to be female (56%) and in the South region (49%). The median LOT decreased from 9.6 days in 2013 to 8.6 days in 2020. The proportion of patients with total LOT > 7 days decreased from 68% in 2013 to 51% in 2020 (% change: -25%); the proportion with post-discharge LOT > 3 days decreased from 73% in 2013 to 63% in 2020 (% change: -14%; Figure 1). Conclusion: The proportion of CAP patients with likely excessive LOT decreased by 25% from 2013-2020, surpassing the 2020 goal. Antibiotic stewardship programs should continue to pursue interventions to reduce excessive length of therapy for common infections. Disclosures: All Authors : No reported disclosures.