Abstract
Background
Although antibiotic stewardship programs (ASPs) have had success in curtailing inappropriate antibiotic use, they remain time- and labor-intensive. To expand the reach of ASPs, approaches to more efficiently target ASP efforts are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in patients hospitalized with community-acquired pneumonia (CAP).
Methods
Within the Hospital of the University of Pennsylvania (HUP) and Penn Presbyterian Medical Center (PPMC), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 300 subjects (150-HUP, 150-PPMC). Inappropriateness of antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established hospital and IDSA guidelines.
Results
Of 300 subjects, median age was 60, 53% were female, and median hospital stay was 4.25 days. Of the 300 subjects, 237 (79%) were admitted to general medicine, hospitalist, family medicine, or geriatrics services. On chart review, 295 (98%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 263 (89%). Of these 263 subjects, 222 (84%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.
Conclusion
An electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate for patients hospitalized for CAP. This algorithm could be used to efficiently target ASP initiatives. The impact of interventions based on this algorithm should be tested in future studies.
Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration
Disclosures
All Authors: No reported disclosures