scholarly journals 119. Procalcitonin to Guide Antibiotic Therapy for Respiratory Infection: A Systematic Review of Systematic Reviews

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S73-S73
Author(s):  
Joshua A York ◽  
Maithili Varadarajan ◽  
Joseph R Yates ◽  
Gavin Barlow
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Therapy ◽  
Respiratory Infection ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Control Group ◽  
Consistent Finding ◽  
Antibiotic Duration ◽  
Course Length ◽  
The Impact

Abstract Background Antimicrobial resistance is an international calamity; closely linked to antibiotic use. Safely reducing antibiotic course length and overall use are imperative. Procalcitonin (PCT) is a biomarker expressed in serum in response to bacterial infection. Systematic reviews (SRs) evaluating PCT as an adjunct to guide antibiotic therapy have been performed but its use remains contentious. The aim of this SR of SRs was to evaluate the extent to which PCT impacts the likelihood of antibiotic initiation and antibiotic duration in cases of respiratory infection. Methods A systematic search of databases using an a priori strategy was conducted. SRs which reported an outcome related to antibiotic initiation and/or duration in the context of respiratory infection were included. Data extraction was performed by the first author and checked independently by a second author. The quality of SRs was assessed by two authors independently using ROBIS criteria. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1 and Table 2). Results 13 SRs were included (see PRISMA diagram). The number of respiratory patients included in these SRs ranged from 308 to 6708 (median = 3457). There was a consistent finding of a statistically significant reduction in antibiotic initiation in the PCT study group compared to the control group (Table 1). SRs that meta-analysed antibiotic duration (n = 9) as a difference in days showed a median reduction of 2.15 days (reduction range 0.80 to 3.83 days) with PCT use. PRISMA Diagram Table 1: Summary of odds ratios/ risk ratios in antibiotic initiation with the use of PCT Conclusion PCT use leads to a reduction in antibiotic initiation for respiratory diseases. It also results in a decrease in antibiotic duration, but this finding was not consistently statistically significant. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Disclosures All Authors: No reported disclosures

scholarly journals 2033. A Systematic Review of Systematic Reviews: Procalcitonin in the ICU to Guide Antibiotic Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S683-S683
Author(s):  
Joshua York ◽  
Maithili Varadarajan ◽  
James Wilson ◽  
Gavin Barlow
Keyword(s):  
Antimicrobial Resistance ◽  
Systematic Reviews ◽  
A Priori ◽  
Study Groups ◽  
Health Crisis ◽  
Consistent Finding ◽  
Number Of Patients ◽  
Antibiotic Duration ◽  
Course Length ◽  
The Impact

Abstract Background Antimicrobial resistance is an emerging global health crisis with overall antimicrobial use a key contributor. Strategies to safely reduce antibiotic course length are important. Procalcitonin (PCT) is a serum biomarker produced in the presence of bacterial infection. There have been many systematic reviews (SRs) evaluating PCT in various populations but its use remains controversial. The aim of this SR of SRs was to evaluate the extent to which PCT in critical care (ICU) impacts antibiotic duration and other reported outcomes. Methods A systematic search of major databases using an “a priori” strategy and protocol was performed. SRs were included if one of the reported outcomes related to antibiotic duration or initiation in the ICU. Data were extracted by an author, checked and corrected independently by another author. The quality of SRs was assessed by 2 authors independently using AMSTAR II. Disagreements were resolved by consensus with a third author. Results are presented narratively and in tabular format (Table 1). Results Figure 1 shows the PRISMA diagram. 19 SRs were included. The number of patients included ranged from 308 to 6,037 (median = 1,316) across SRs. Overall, there was a consistent finding of a statistically significant (sf) reduction in antibiotic duration in study groups using PCT cessation protocols (all studies in Table 1). 3 SRs did not contain suitable statistics for inclusion in Table 1. SRs that presented the antibiotic duration outcome as a mean or median difference in exposure days (N = 16) showed a median reduction of 2.10 days (range −1.19 to -5) with PCT use. 1 SR found an sf decrease in mortality with PCT use. 4 SRs included antibiotic initiation as an outcome: 2 found an sf decrease in antibiotic prescription rate with PCT; 2 found no difference. Conclusion SRs have found that PCT use in ICU leads to an sf reduction in antibiotic duration without impacting mortality. There are no data presented in the SRs about the impact of this on antimicrobial resistance. Few SRs detail the infections included; thus the applicability of these findings to a single ICU remains challenging. Other outcomes, such as length of stay, are not affected by PCT use in ICU. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of the impact of antimicrobial use protocols in PRRS virus infected swine on phenotypic antimicrobial resistance patterns

2021 ◽  
Author(s):  
Carissa A. Odland ◽  
Roy Edler ◽  
Noelle R. Noyes ◽  
Scott A. Dee ◽  
Joel Nerem ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Longitudinal Studies ◽  
Bacterial Infections ◽  
Population Level ◽  
Control Group ◽  
Antimicrobial Use ◽  
Treatment Groups ◽  
Resistance Patterns ◽  
The Impact ◽  
Over Time

A longitudinal study was conducted to assess the impact of different antimicrobial exposures of nursery-phase pigs on patterns of phenotypic antimicrobial resistance in fecal indicator organisms throughout the growing phase. Based on practical approaches used to treat moderate to severe PRRSV-associated secondary bacterial infections, two antimicrobial protocols of differing intensity of exposure [44.1 and 181.5 animal-treatment days per 1000 animal days at risk (ATD)] were compared with a control group with minimal antimicrobial exposure (2.1 ATD). Litter-matched pigs (n = 108) with no prior antimicrobial exposure were assigned randomly to the treatment groups. Pen fecal samples were collected nine times during the wean-to-finish period and cultured for Escherichia coli and Enterococcus spp. Antimicrobial susceptibility testing was conducted using NARMS gram-negative and gram-positive antibiotic panels. Despite up to 65-fold difference in ATD, few and modest differences were observed between groups and over time. Resistant patterns at marketing overall remained similar to those observed at weaning, prior to any antimicrobial exposures. Those differences observed could not readily be reconciled with the patterns of antimicrobial exposure. Resistance of E. coli to streptomycin was higher in the group exposed to 44.1 ATD, but no aminoglycosides were used. In all instances where resistance differed between time points, the higher resistance occurred early in the trial prior to any antimicrobial exposures. These minimal impacts on AMR despite substantially different antimicrobial exposures point to the lack of understanding of the drivers of AMR at the population level and the likely importance of factors other than antimicrobial exposure. IMPORTANCE Despite a recognized need for more longitudinal studies to assess the effects of antimicrobial use on resistance in food animals, they remain sparse in the literature, and most longitudinal studies of pigs have been observational. The current experimental study had the advantages of greater control of potential confounding, precise measurement of antimicrobial exposures which varied markedly between groups and tracking of pigs until market age. Overall, resistance patterns were remarkably stable between the treatment groups over time, and the differences observed could not be readily reconciled with the antimicrobial exposures, indicating the likely importance of other determinants of AMR at the population level.

scholarly journals Inconsistencies are common between non-Cochrane systematic reviews and their protocols registered in the International prospective register of systematic reviews (PROSPERO) but were seldom explained

2020 ◽  
Author(s):  
Kaiyan Hu ◽  
Ting Zhang ◽  
Weiyi Zhang ◽  
Qi Zhou ◽  
Mengyao Jiang New ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Data Extraction ◽  
Meta Analysis ◽  
Reporting Quality ◽  
Fundamental Solutions ◽  
Cochrane Reviews ◽  
Or Methodology ◽  
Retrospective Comparative Study ◽  
The Impact

Abstract Background: Protocols of systematic reviews allow for planning and documentation of review methods and thus improve the transparency of the reviews process. However, pre-registration of a protocol is not enough, the author also need to follow it. PROSPERO is an open-access online database for the registration of non-Cochrane systematic reviews. The purpose of this study is to compare published non-Cochrane reviews with their pre-registered protocols on PROSPERO to determine what changes, if any, have been made, and how likely these changes are to impact the quality of systematic review. Methods: This is a retrospective comparative study. We searched for protocols on PROSPERO platform that were registered in 2018 and then selected the protocols that full text have been published as of January 1st 2019. Published full texts were identified through the protocol's final publication citation. Two authors independently compared and identified changes between protocols and systematic reviews and then evaluated the impact (improve, reduce, or unclear) of these changes on the reporting or methodology quality of reviews. Descriptive statistics of percentage (%) and frequency (n) were conducted. Results: We identified 39 pairs, all of which exhibited changes. “Search strategy”(92%, n=36), “data extraction”(90%, n=35), “data synthesis”(77%, n=30), “outcome”(64%, n=24), and “subgroup analysis”(64%, n=24) all showed significant changes. All changes to only one review were considered to improve the reporting or methodology quality, and the remaining 97% of reviews (n=38) contained changes that were considered to reduce the methodology or reporting quality or that had an unclear impact on systematic reviews. Conclusions: Changes between the non-Cochrane systematic reviews and their protocols recorded on PROSPERO were widespread. Some of the changes reduced the methodology or reporting quality of systematic reviews or had an unclear impact. Measures should be taken to further improve the transparency of the non-Cochrane systematic reviews. Adding a new item in updated “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) and “Meta-analysis of Observational Studies in Epidemiology” (MOOSE) to guide reporting and explaining the changes, as well as advising peer reviewers (and editors) to check the reviews against the protocols are two suggested fundamental solutions.

scholarly journals 2148. Performance of the BioFire FilmArray Gastrointestinal Panel in a Clinical Setting of Infectious Diarrhea

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S728-S728
Author(s):  
Gloria Mayela Aguirre-García ◽  
Alejandra Moraila-Baez ◽  
Adrian Camacho-Ortiz
Keyword(s):  
Length Of Stay ◽  
Antibiotic Therapy ◽  
Acute Diarrhea ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Infectious Diarrhea ◽  
Conventional Methods ◽  
Therapy Modification ◽  
The Impact

Abstract Background Infectious diarrhea remains as one of the leading causes of morbidity and mortality worldwide among all age groups. Conventional methods for diagnosis are time consuming and expensive. The BioFire FilmArray gastrointestinal panel (FA-GIP) tests for 22 enteric pathogens, provides results in a few hours and improves healthcare costs. The impact on antibiotic stewardship is unknown. Methods We conducted a retrospective cohort, multi-center study to evaluate FA-GIP clinical performance in hospitalized patients with acute diarrhea. Patients from 3 hospitals from the Christus Muguerza health group were included between January 2017 and August 2018. The FA-GIP was ordered by the treating physician and was not influenced by the study. Duration of antibiotic therapy, length of hospital stay, and therapy modification were assessed. The comparison group consisted of patients with acute diarrhea in which no FA-GIP was ordered. Results Data from 130 patients with FA-GIP and 107 patients with conventional methods were collected. Pathogens were detected by FA-GIP in 72.3% of the cases. The median of duration of antibiotic therapy in FA-GIP group was 5 days (IQR 0–8) vs. 3 days (IQR 0–6) in conventional methods group, (P < 0.05). The mean length of stay was 3.3(SD ± 2.4) in FA-GIP group vs. 1.9 (SD ± 1.0) in the control group (P < 0.05). Patients in FA-GIP group had more days with diarrhea, lower hemoglobin levels, and higher creatinine levels at admission (Table 1). The most frequent pathogens detected were enteropathogenic Escherichia coli in 24.4%, norovirus in 19.1%, Clostridium difficile in 17.0% and Campylobacter jejuni in 15.9% (Table 2). Therapy modification after FA-GIP results was made in 51.1% of the patients with a detected pathogen, and in 42.8% of patients with no pathogen detected in FA-GIP the antibiotic was stopped. Conclusion Patients in the FA-GIP group had a more complex clinical scenario upon admission, they also had a longer duration of antibiotic therapies and longer length of stay. Although antibiotic therapy was positively influenced by the FA-GIP result, and no pathogen detection leads to withdrawal of unnecessary antibiotics. Disclosures All authors: No reported disclosures.

IMPACT OF ZINC SUPPLEMENTATION ON MORBIDITY FROM DIARRHEA NAD ACUTE RESPIRATORY INFECTIONS AMONG MALNOURISHED CHILDREN AGED UNDER 5 YEARS AT HUONG HO COMMUNNE, HUONG TRA DISTRICT, THUA THIEN HUE PROVINCE

2011 ◽  
pp. 91-98
Author(s):  
Thu Cu Nguyen
Keyword(s):  
Respiratory Infection ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Control Group ◽  
Study Group ◽  
Study Methods ◽  
Zinc Supplement ◽  
And Control ◽  
The Impact ◽  
Children Under 5

Tittle: study the impact of Zinc supplement on acute respiratory infection and diarrhea in children under 5 yrs at Huong ho commune, Huong tra district, Thua Thien Hue province. Background: diarhea and pneumonia are two common diseases in malnutrition children. The studies showed that zinc is a microsubstance to improve the immune capacicty of children. Many studies showed that malnutrition children gone with zinc deficiency. The study is aim to assess the impact of zinc supplement on malnutrition children with diarrhea and acute respiratory infection (ARI). Population and study methods: Population: 129 malnutrition children under 5 yrs living at Huong ho commune, Huong tra district, Thua Thien Hue province. Study methods: intervene at community with control group. 2 groups of children have the similarity of age, sex, level of malnutrition, avarage weight. Study group: supplement with Zinc 10 mg/day x 30 days. Control group: no zinc supplement. Both groups were followed up about diarrhea and ARI every week in 6 months. Result: In 6 months, there was 24,6% of children in study group has the diseases while in control group was 43,7% (p<0,05). Avarage time of diarrhea per period in study group was shorter significantly than in control group (4,1±0,8 vs 6,0±1,4) (p<0,01). There was no diferrence in average diarrhea period, incidence of diarrhea between study group and control group. There still did not find out the difference in ARI period, incidence of ARI between study group and control group. Conclusion: Zinc supplement for malnutrition children is to reduce the general acquired rate of diarrhea and ARI, especially to reduce the time of diarrhea period. This study did not find out the improvement of acquired ARI in study group with zince supplement. Keywords: Malnutrition, zinc, diarrhea

scholarly journals Procalcitonin-Guided Antibiotic Therapy Reduces Antibiotic Use for Lower Respiratory Tract Infections in a United States Medical Center: Results of a Clinical Trial

2018 ◽  
Vol 5 (12) ◽  
Author(s):  
Jennifer Townsend ◽  
Victoria Adams ◽  
Panagis Galiatsatos ◽  
David Pearse ◽  
Hardin Pantle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Adverse Outcomes ◽  
Control Group ◽  
Lower Respiratory Tract Infections ◽  
Antibiotic Duration ◽  
Tract Infections

Abstract Background European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTIs) have demonstrated significant reductions in antibiotic use without increasing adverse outcomes. Few studies have examined PCT for LRTIs in the United States. Methods In this study, we evaluated whether a PCT algorithm would reduce antibiotic exposure in patients with LRTI in a US hospital. We conducted a controlled pre-post trial comparing an intervention group of PCT-guided antibiotic therapy to a control group of usual care. Consecutive patients admitted to medicine services and receiving antibiotics for LRTI were enrolled in the intervention. Providers were encouraged to discontinue antibiotics according to a PCT algorithm. Control patients were similar patients admitted before the intervention. Results The primary endpoint was median antibiotic duration. Overall adverse outcomes at 30 days comprised death, transfer to an intensive care unit, antibiotic side effects, Clostridium difficile infection, disease-specific complications, and post-discharge antibiotic prescription for LRTI. One hundred seventy-four intervention patients and 200 controls were enrolled. Providers complied with the PCT algorithm in 75% of encounters. Procalcitonin-guided therapy reduced median antibiotic duration for pneumonia from 7 days to 6 (P = .045) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) from 4 days to 3 (P = .01). There was no difference in the rate of adverse outcomes in the PCT and control groups. Conclusions A PCT-guided algorithm safely reduced the duration of antibiotics for treating LRTI. Utilization of a PCT algorithm may aid antibiotic stewardship efforts. This clinical trial was a single-center, controlled, pre-post study of PCT-guided antibiotic therapy for LRTI. The intervention (incorporation of PCT-guided algorithms) started on April 1, 2017: the preintervention (control group) comprised patients admitted from November 1, 2016 to April 16, 2017, and the postintervention group comprised patients admitted from April 17, 2017 to November 29, 2017 (Supplementary Figure 1). The study comprised patients admitted to the internal medicine services to a medical ward, the Medical Intensive Care Unit (MICU), the Cardiac Intensive Care Unit (CICU), or the Progressive Care Unit (PCU) “step down unit”. The registration data for the trails are in the ClinicalTrials.gov database, number NCT0310910.

scholarly journals Vertical Transmission of Gut Microbiome and Antimicrobial Resistance Genes in Infants Exposed to Antibiotics at Birth

2020 ◽  
Author(s):  
Weizhong Li ◽  
Terhi Tapiainen ◽  
Lauren Brinkac ◽  
Hernan A Lorenzi ◽  
Kelvin Moncera ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Vertical Transmission ◽  
Gut Microbiome ◽  
Treated Group ◽  
Control Group ◽  
Gut Colonization ◽  
Antimicrobial Resistance Genes ◽  
Major Route ◽  
Group 10 ◽  
The Impact

Abstract Vertical transmission of maternal microbes is a major route for establishing the gut microbiome in newborns. The impact of perinatal antibiotics on vertical transmission of microbes and antimicrobial resistance is not well understood. Using a metagenomic approach, we analyzed the fecal samples from mothers and vaginally delivered infants from a control group (10 pairs) and a treatment group (10 pairs) receiving perinatal antibiotics. Antibiotic-usage had a significant impact on the main source of inoculum in the gut microbiome of newborns. The control group had significantly more species transmitted from mothers to infants (P = .03) than the antibiotic-treated group. Approximately 72% of the gut microbial population of infants at 3–7 days after birth in the control group was transmitted from their mothers, versus only 25% in the antibiotic-treated group. In conclusion, perinatal antibiotics markedly disturbed vertical transmission and changed the source of gut colonization towards horizontal transfer from the environment to the infants.

scholarly journals Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review

2020 ◽  
Vol 42 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Elaine C. Toomey ◽  
Yvonne Conway ◽  
Chris Burton ◽  
Simon Smith ◽  
Michael Smalle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Evidence Base ◽  
World Health ◽  
Healthcare Organizations ◽  
Surgical Masks ◽  
Single Use ◽  
Current Guidance ◽  
The Impact

AbstractBackground:Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination.Objectives:To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators.Data sources:We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews.Methods:Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized.Results:In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale.Conclusions:Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

scholarly journals Impact and use of reviews and ‘overviews of reviews’ to inform clinical practice guideline recommendations: protocol for a methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031442
Author(s):  
Carole Lunny ◽  
Cynthia Ramasubbu ◽  
Savannah Gerrish ◽  
Tracy Liu ◽  
Douglas M Salzwedel ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Systematic Reviews ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Data Extraction ◽  
Meta Analysis ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Meta Analyses ◽  
The Impact

IntroductionGuidelines are systematically developed recommendations to assist practitioner and patient decisions about treatments for clinical conditions. High quality and comprehensive systematic reviews and ‘overviews of systematic reviews’ (overviews) represent the best available evidence. Many guideline developers, such as the WHO and the Australian National Health and Medical Research Council, recommend the use of these research syntheses to underpin guideline recommendations. We aim to evaluate the impact and use of systematic reviews with and without pairwise meta-analysis or network meta-analyses (NMAs) and overviews in clinical practice guideline (CPG) recommendations.Methods and analysisCPGs will be retrieved from Turning Research Into Practice and Epistemonikos (2017–2018). The retrieved citations will be sorted randomly and then screened sequentially by two independent reviewers until 50 CPGs have been identified. We will include CPGs that provide at least two explicit recommendations for the management of any clinical condition. We will assess whether reviews or overviews were cited in a recommendation as part of the development process for guidelines. Data extraction will be done independently by two authors and compared. We will assess the risk of bias by examining how each guideline developed clinical recommendations. We will calculate the number and frequency of citations of reviews with or without pairwise meta-analysis, reviews with NMAs and overviews, and whether they were systematically or non-systematically developed. Results will be described, tabulated and categorised based on review type (reviews or overviews). CPGs reporting the use of the Grading of Recommendations, Assessment, Development and Evaluation approach will be compared with those using a different system, and pharmacological versus non-pharmacological CPGs will be compared.Ethics and disseminationNo ethics approval is required. We will present at the Cochrane Colloquium and the Guidelines International Network conference.

scholarly journals A Multicenter Stewardship Initiative to Decrease Excessive Duration of Antibiotic Therapy for the Treatment of Community-Acquired Pneumonia (CAP)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S64
Author(s):  
Farnaz Foolad ◽  
Angela Huang ◽  
Cynthia Nguyen ◽  
Lindsay Colyer ◽  
Megan Lim ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Total Duration ◽  
Audit And Feedback ◽  
Patient Specific ◽  
Control Group ◽  
Duration Of Therapy ◽  
The Impact ◽  
Research Grant

Abstract Background Hospitals have implemented multifaceted approaches to quickly identify CAP, start timely therapy, and reduce hospital readmission, yet there has been minimal focus on providing appropriate duration of therapy. The IDSA CAP guidelines recommend 5 days of antibiotic therapy for patients that are clinically stable and quickly defervesce. However, previous publications suggest duration of therapy for CAP may be unnecessarily prolonged. Methods The objective of this multicenter, quasi-experimental study of hospitalized patients with CAP was to assess the impact of a prospective 6-month stewardship intervention on total duration of antibiotic therapy and associated clinical outcomes. All centers updated institutional CAP guidelines to promote IDSA-concordant durations of therapy and provided education to pharmacists and prescribers. Daily patient-specific prospective audit and feedback was provided by infectious diseases stewardship pharmacists to optimize compliance with guideline recommendations. Results A total of 600 patients were included (307 in the historic control group and 293 in the stewardship intervention group). The stewardship intervention led to significantly increased rates of compliance with IDSA duration of therapy recommendations (5.6% vs. 41.4%, P&lt; &lt; 0.01) and significantly reduced the duration of therapy for CAP (9 vs. 6 days, P &lt; 0.01). Inappropriate days of antibiotic therapy was reduced in the intervention group (4 vs. 1.6 days, P &lt; 0.01), and total avoidance of 720 excessive days of antibiotic therapy. Clinical outcomes, including mortality, length of hospitalization, readmission to hospital with pneumonia, presentation to the ER/clinic with pneumonia within 30 days of discharge, and incidence of C. difficilecolitis, were not different between groups. Conclusion This multicenter evaluation of a prospective stewardship intervention in hospitalized CAP patients reduced the total duration of antibiotic therapy and increased compliance with guideline-concordant duration of therapy without adversely affecting patient outcomes. This project was funded through a competitive stewardship grant provided by Merck & Co. Disclosures A. Huang, Merck: Grant Investigator, Research grant; C. Nguyen, Merck: Grant Investigator, Research grant; J. Grieger, Merck: Grant Investigator, Research grant; S. Revolinski, Merck: Grant Investigator, Research grant; J. Li, Merck: Grant Investigator, Research grant; M. Mack, Merck: Grant Investigator, Research grant; J. N. Wainaina, Merck: Grant Investigator, Research grant; G. Eschenauer, Merck: Grant Investigator, Research grant; T. Patel, Merck: Grant Investigator, Research grant; V. Marshall, Merck: Grant Investigator, Research grant; J. Nagel, Merck: Grant Investigator, Research grant

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