scholarly journals EFFECT OF THE ANTIVIRAL DRUG KAGOCEL® ON THE LEVELS OF MATRIX METALLOPROTEINASES MMP-8 AND MMP-9 AND THEIR TISSUE INHIBITORS TIMP-1 AND TIMP-2 IN INDUCED SPUTUM IN THE COMBINED TREATMENT OF COMMUNITY-ACQUIRED VIRAL-BACTERIAL PNEUMONIA

2021 ◽  
Author(s):  
A. F. Popov ◽  
E. V. Markelova ◽  
I. A. Komarova ◽  
A. V. Kosciuszko ◽  
M. Yu. Shchelkanov
Keyword(s):  
Reference Values ◽  
Bacterial Pneumonia ◽  
Combined Treatment ◽  
Research Work ◽  
Antiviral Drug ◽  
Community Acquired Pneumonia ◽  
Induced Sputum ◽  
Tissue Inhibitors ◽  
Control Value ◽  
Days Of Therapy

The effect of the antiviral drug Kagocel on the levels of metalloproteinases MMP-8 and MMP-9 and their tissue inhibitors TIMP-1 and TIMP-2 in induced sputum in the treatment of community-acquired viral-bacterial pneumonia was analyzed. 60 adult patients with a confirmed diagnosis of community-acquired pneumonia and viral-bacterial etiology were included in the follow-up research work. Materials and methods. All patients were randomly divided into 2 groups: 1 group (comparison group) included 30 patients receiving Ceftriaxone monotherapy; in the 2nd group (main) - 30 people who were prescribed Ceftriaxone and the antiviral drug Kagocel as etiotropic treatment. Both groups were comparable in terms of gender, age and time of admission to the hospital. Results. During hospitalization, patients in both groups had elevated levels of MMP-8, MMP-9, TIMP-1 and TIMP-2 in induced sputum compared to the reference values. By 7 days of inpatient treatment, the level of MMP-8 continued to be significantly higher than the reference values ​​in both groups, and in patients of the 2nd group there was a decrease compared to baseline values, and in patients in the 1st group at the same time. The activity of MMP-9 during hospitalization was also high in patients of both groups compared with the level of these enzymes in healthy people. By the 7th day of therapy various indicators' changes were recorded. The level of MMP-9 in patients of the 1st group increased, and in patients of the 2nd group - on the contrary - decreased. The level of TIMP-1 decreased in patients of the 1st group below the control value, and in patients of the 2nd group - reached the reference values. The level of TIMP-2 decreased in both groups and reached the level of control values. Conclusion. Inclusion in the standard antibacterial regimen of community-acquired viral-bacterial pneumonia of the antiviral drug Kagocel reduces the level of MMR-9 and reduces the severity of the imbalance in the MMP and TIMP system by 7 days of therapy, which leads to a faster clinical recovery of patients.

scholarly journals Effectiveness of antiviral drug Kagocel® in complex treatment of viral and bacterial pneumonia in hospital

2019 ◽  
Vol 2 (27) ◽  
pp. 14-18
Author(s):  
A. F. Popov ◽  
A. I. Simakova ◽  
I. A. Komarova
Keyword(s):  
Antibacterial Therapy ◽  
Bacterial Pneumonia ◽  
Viral Infections ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Research Work ◽  
Antiviral Drug ◽  
Influenza Viruses ◽  
Control Group ◽  
Antibacterial Drug

Viruses that cause acute respiratory infections are currently widespread and are reported worldwide. Among the most dangerous among them are influenza viruses, with a difficult to predict course and the possibility of rapidly developing life-threatening complications that can lead to death.The purpose of the research work: to analyze the effectiveness and safety of the treatment of community-acquired viral-bacterial pneumonia in hospital patients using only antibacterial therapy as an etiotropic treatment in comparison with the combined use of antibacterial therapy and the antiviral drug Kagocel®.Materials and methods. An open, prospective comparative study was conducted (from January 1 to December 31, 2018) to study the effectiveness of monotherapy compared with combination therapy with the antiviral drug Kagocel® for 60 patients diagnosed with community-acquired pneumonia who were admitted during the period of an epidemic rise in the incidence of acute respiratory viral infections and influenza. All patients were treated in the infectious ward of the Regional Clinical Hospital No. 2, (Vladivostok, Russia). Patients were divided into 2 groups, 30 people each, comparable in age, gender and timing of admission to the hospital. The age of patients ranged from 18 to 65 years. The first group consisted of patients who received an antibacterial drug (control group) as an etiotropic therapy, the second group — those who received a combination of antibacterial and antiviral (Kagocel®) drugs (experimental group).Results. In the group of patients receiving both antibacterial and antiviral therapy with Kagocel®, there was a significant reduction in the duration of the febrile period and catarrhal manifestations compared with patients taking only antibiotics as part of etiotropic therapy. An analysis of the data showed that the use of Kagocel® in the treatment of viral-bacterial pneumonia significantly facilitates the patient’s condition during the illness, shortens the duration of the disease, reduces the duration of the main clinical symptoms of pneumonia, namely the duration of intoxication, catarrhal syndromes, and physical changes in the lungs.Conclusions. The use of the antiviral drug Kagocel® in the treatment of community-acquired viral-bacterial pneumonia leads to a more rapid relief of the main symptoms of the disease and reduces the duration of the disease. Good tolerance of the therapy, the absence of adverse reactions was noted.

Influence of Kagocel upon IL‑10 and TNF-α levels in treatment of community-acquired viral-bacterial pneumonia

2020 ◽  
pp. 70-75
Author(s):  
A. F. Popov ◽  
E. V. Markelova ◽  
I. A. Komarova ◽  
A. V. Kostyushko ◽  
A. I. Simakova ◽  
...  
Keyword(s):  
Bacterial Pneumonia ◽  
Day Treatment ◽  
Antiviral Drug ◽  
Community Acquired Pneumonia ◽  
Antibacterial Drug ◽  
Combined Use ◽  
Blood Cytokines ◽  
Tnf Α ◽  
Duration Of Hospitalization ◽  
Anti Inflammatory

Introduction. Cytokines regulate intercellular and intersystem interactions and are involved in the development and prevention of various pathologies. Purposes of work were a comparative assessment of the dynamics of the levels of pro- and anti-inflammatory blood cytokines (TNF-α and IL‑10) in patients with community-acquired viral-bacterial pneumonia (CAVBP) with ceftriaxone monotherapy with antibiotic and combined use this antibiotic with the antiviral drug Kagocel, and comparison of getting data with native (reference) indicators of healthy patients.Materials and methods. The study included 60 patients, aged 18–65 years, with a confirmed diagnosis of community-acquired pneumonia of moderate severity, divided into two groups equal in number, comparable by gender, age and timing of admission to the hospital. The first group received intravenous monotherapy only with the antibacterial drug Ceftriaxone, and the second group received a combination of Ceftriaxone with the oral antiviral drug Kagocel. Results. A pronounced imbalance of the levels of proand anti-inflammatory cytokines in patients with CAVBP of both groups was demonstrated both during the onset of the disease and on the 7th day hospitalization. When analyzing the concentration ratio of TNF-α / IL‑10, it was found that monotherapy with an antibacterial drug did not lead to a decrease in this indicator, while when using a combination of an antibiotic with an antiviral drug, a significant decrease in its values to normal was observed on the 7th day treatment. Good tolerance of the combination therapy and the absence of adverse reactions were noted.Conclusion. The addition of Kagocel to the treatment regimen for CAVBP with ceftriaxone contributed to the decrease the concentration of TNF-α and increases the level of IL‑10, which is clinically reflected in a reduction in the duration of fever, symptoms of general intoxication, catarrhal phenomena and the duration of hospitalization (by 1 day) compared with ceftriaxone monotherapy.

The new technology of waste water treatment by using bioreactors with bio membranous movable bed – biochips

2020 ◽  
Vol 10 (3) ◽  
pp. 276-292
Author(s):  
Maria Y. Savostyanova ◽  
◽  
Lidia А. Norina ◽  
Arina V. Nikolaeva ◽  
◽  
...  
Keyword(s):  
Waste Water ◽  
Water Treatment ◽  
Water Resources ◽  
Waste Water Treatment ◽  
Combined Treatment ◽  
Research Work ◽  
Pollution Level ◽  
Waste Waters ◽  
Treatment Facilities ◽  
Movable Bed

Retaining of water resources quality is one of the global ecological problems of the modern time. The most promising direction in solving the problem of water resources protection is the reduction of negative environmental influence of waste water from production facilities by upgrading the existing water treatment technologies. To treat utility water, technical and rain water from site facilities of Transneft system entities, the specialists developed and approved standard technological diagrams, which are used in producing treatment facilities. The standard technological diagrams provide for all necessary stages of waste water treatment ensures the reduction of pollution level to normal values. However, during operation of treatment facilities it was established, that to ensure the required quality of waste water treatment with initially high levels of pollution, the new technological solutions are necessary. The author presents the results of scientific-research work, in the context of which the best affordable technologies were identified in the area of the treatment of waste water with increased content of pollutants and non-uniform ingress pattern. On the basis of the research results the technical solutions were developed for optimization of operation of existing waste water treatment facilities by means of using combined treatment of technical and rain waters and utility waste waters and applying bioreactor with movable bed – biochips. The use of bioreactor with movable bed allows the increase in the area of active surface, which facilitates increase and retention of biomass. Biochips are completely immersed into waste waters, and biofilm is formed on the entire volume of immersion area, facilitating retention of biomass and preventing formation of sediments. Due to mixing the floating device with biofilm constantly moves along the whole area of bioreactor, and, in doing so, speeds up biochemical processes and uniformity of treatment. The advantages of a bioreactor with movable bed – its active sludge durability against increased and changing pollutant concentrations, change of waste water temperature and simplicity of application – ensured the possibility of its use for blending utility waters, technical and rain waters.

Solubility Enhancement of Poorly Water-Soluble Antifungal Drug Acyclovir by Nanocrystal Formulation Approach

2018 ◽  
Vol 11 (2) ◽  
pp. 4036-4042
Author(s):  
Prakash Goudanavar ◽  
Ankit Acharya ◽  
Vinay C.H
Keyword(s):  
Chemical Interaction ◽  
Research Work ◽  
Antiviral Drug ◽  
In Vitro Release ◽  
Oral Route ◽  
Water Soluble ◽  
Precipitation Method ◽  
Dsc Studies ◽  
Ft Ir

Administration of an antiviral drug, acyclovir via the oral route leads to low and variable bioavailability (15-30%). Therefore, this research work was aimed to enhance bioavailability of acyclovir by nanocrystallization technique. The drug nanocrystals were prepared by anti-solvent precipitation method in which different stabilizers were used. The formed nanocrystals are subjected to biopharmaceutical characterization including solubility, particle size and in-vitro release. SEM studies showed nano-crystals were crystalline nature with sharp peaks. The formulated drug nanocrystals were found to be in the range of 600-900nm and formulations NC7 and NC8 showed marked improvement in dissolution velocity when compared to pure drug, thus providing greater bioavailability. FT-IR and DSC studies revealed the absence of any chemical interaction between drug and polymers used. 

scholarly journals Evaluation of LBM415 (NVP PDF-713), a Novel Peptide Deformylase Inhibitor, for Treatment of Experimental Mycoplasma pneumoniae Pneumonia

2005 ◽  
Vol 49 (10) ◽  
pp. 4128-4136 ◽  
Author(s):  
Monica Fonseca-Aten ◽  
Christine M. Salvatore ◽  
Asunción Mejías ◽  
Ana M. Ríos ◽  
Susana Chávez-Bueno ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Mycoplasma Pneumoniae ◽  
Bronchoalveolar Lavage Fluid ◽  
Lavage Fluid ◽  
Placebo Treatment ◽  
Community Acquired Pneumonia ◽  
Peptide Deformylase ◽  
Necrosis Factor Alpha ◽  
Days Of Therapy ◽  
Ifn Γ

ABSTRACT Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. We evaluated the efficacy of LBM415, a novel peptide deformylase inhibitor antimicrobial agent, for the treatment of M. pneumoniae pneumonia in a mouse model. Eight-week-old BALB/c mice were intranasally inoculated once with 107 CFU of M. pneumoniae. Groups of mice were treated with LBM415 (50 mg/kg of body weight) or placebo subcutaneously daily for 13 days, starting 24 h after inoculation. Groups of mice were evaluated at the baseline; at days of treatment 1, 3, 6, and 13; and at 7 days after treatment. The MIC of LBM415 against M. pneumoniae was <0.005 μg/ml. LBM415-treated mice had significantly lower bronchoalveolar lavage fluid M. pneumoniae concentrations than placebo-treated mice on days 6 and 13 of treatment. Compared with placebo treatment, therapy with LBM415 significantly decreased lung histopathology scores at days 3, 6, and 13 of treatment and at 7 days after treatment. Airway obstruction was significantly lower in LBM415-treated mice than in placebo-treated mice on days 1, 3, and 6 of treatment and after 7 days of therapy, while airway hyperresponsiveness was significantly lower only on day 3 of therapy. The bronchoalveolar lavage fluid concentrations of tumor necrosis factor alpha, gamma interferon (IFN-γ), interleukin-6 (IL-6), IL-12, KC (functional IL-8), monocyte chemotactic protein 1, macrophage inflammatory protein 1α, monokine induced by IFN-γ, and IFN-inducible protein 10 were significantly reduced in LBM415-treated mice compared with the levels in placebo-treated mice. There were no differences in the bronchoalveolar lavage fluid concentrations of granulocyte-macrophage colony-stimulating factor, IL-1β, IL-2, IL-4, IL-5, and IL-10 between the two groups of mice. LBM415 therapy had beneficial microbiologic, histologic, respiratory, and immunologic effects on acute murine M. pneumoniae pneumonia.

A Clinical Pharmacy-Oriented Drug Surveillance Network: Results of a Nationwide Antibiotic Utilization Review of Bacterial Pneumonia–1987

DICP ◽  
1989 ◽  
Vol 23 (2) ◽  
pp. 162-170
Author(s):  
Thaddeus H. Grasela ◽  
Jerome J. Schentag ◽  
Steven J. Boekenoogen ◽  
Kenneth D. Crist ◽  
William L. Lowes ◽  
...  
Keyword(s):  
Bacterial Pneumonia ◽  
Prescribing Patterns ◽  
Oral Drug ◽  
Utilization Review ◽  
Antibiotic Prescribing ◽  
Drug Surveillance ◽  
Surveillance Network ◽  
Gram Negative ◽  
Days Of Therapy ◽  
Culture Positive

One hundred eighteen pharmacists enrolled in the Drug Surveillance Network completed a survey of antibiotic prescribing patterns for bacterial infections. A total of 319 hospitalized patients being treated for suspected or documented bacterial pneumonia were monitored, and this paper summarizes the data collected on this specific subpopulation. Two hundred three patients (64 percent) were treated for community-acquired pneumonia and 116 patients (36 percent) were treated for nosocomial pneumonia. Seventy-three percent of the nosocomial pneumonias were culture-positive, with a gram-negative microorganism as the predominant isolate. Forty-eight percent of the community-acquired pneumonias were culture-positive with a mixture of gram-positive and gram-negative organisms. Fifty percent of patients were treated with a single agent, 33 percent with two antibiotics, and the remaining 17 percent with a combination of three or more antibiotics. A satisfactory response was noted for 62 and 76 percent of the patients with nosocomial and community-acquired pneumonias, respectively. Twenty percent of the pneumonia patients were switched to oral drug after an average of five days of therapy and discharged from the hospital. Twenty-five adverse events that were possibly or probably related to the antibiotic regimen were reported in 23 of the 350 patients for an overall incidence of 6.5 percent. The results of this survey provide a cross-sectional view of antibiotic prescribing patterns for the treatment of bacterial pneumonia and the outcome of therapy under actual clinical conditions of use.

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals 42. A Pharmacist-Led Intervention to Decrease Anaerobic Coverage for Hospitalized Patients with Community-Acquired Pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S44-S45
Author(s):  
Maxx O Enzmann ◽  
Courtney M Pagels ◽  
Emily J Perry ◽  
Justin Jones ◽  
Paul Carson
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
American Thoracic Society ◽  
Hospitalized Patients ◽  
Guidance Document ◽  
Antibiotic Exposure ◽  
Antibiotic Regimen ◽  
Days Of Therapy

Abstract Background Community-acquired pneumonia (CAP) is frequently mis-categorized as aspiration pneumonia, prompting the addition of anaerobic coverage to the antibiotic regimen. In our institution, this usually takes the form of adding metronidazole to ceftriaxone. The 2019 American Thoracic Society and Infectious Diseases Society of America CAP guidelines recommend anaerobic coverage only for hospitalized patients with a suspected lung abscess or empyema. The objective of this study was to determine if a pharmacist-led workflow could increase adherence to the 2019 CAP guideline recommendations by limiting anaerobic coverage to those rare occasions. Methods The hospital antimicrobial stewardship committee approved a pharmacist workflow and guidance document which outlines criteria to evaluate appropriateness of anaerobic coverage for hospitalized patients with CAP and no other indications for antibiotics. If anaerobic coverage is not indicated, the pharmacist submits a standardized message to the treating provider via the electronic medical record, recommending discontinuation of metronidazole. This workflow was implemented on October 3, 2019. Metronidazole days of therapy (DOT) per 1000 patient days in quarters 1 through 4 of 2019 and quarter 1 of 2020 were collected as well as percent acceptance of documented pharmacist interventions from October 3, 2019 until March 31, 2020. Results Between October 3, 2019 and March 31, 2020, a total of 221 interventions were made by pharmacists to discontinue metronidazole in hospitalized CAP patients where anaerobic coverage was not indicated. Out of those 221 interventions, 164 (74%) were accepted by providers and only 57 (26%) were rejected. The DOT per 1000 patient days of metronidazole was assessed for the three quarters prior to our intervention and the two quarters after the intervention. Compared to the three quarters prior, metronidazole DOT per 1000 patient days decreased by 26.6% for the two quarters following implementation of the pharmacist-led intervention (Figure 1). Figure 1: Metronidazole DOT per 1000 patient days from January 1, 2019 through March 31, 2020. Vertical line indicates when pharmacist workflow was implemented. Conclusion A pharmacist antimicrobial stewardship intervention at our institution increased adherence to CAP guidelines and decreased unnecessary antibiotic exposure in hospitalized CAP patients when anaerobic coverage was not indicated. Disclosures All Authors: No reported disclosures

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

2021 ◽  
pp. 001857872110557
Author(s):  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
Casey J. Dempsey ◽  
Joseph L. Kuti ◽  
David P. Nicolau ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Provider Education ◽  
Broad Spectrum Antibiotic ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Days Of Therapy ◽  
Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

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