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• W2282499342 abstract "•This is the first study to account for any time-dependent bias; previous studies have incorrectly modeled antimicrobial stewardship interventions (ASis) as though present on admission, but this study models ASis as a time-dependent variable in the final survival analysis. •This is the first community-acquired pneumonia length of stay study to use a stepped-wedge design to ensure contemporaneous controls. •There has only been 1 previous community-acquired pneumonia length of stay study modeled as a time to event outcome, and this study is the first to test the assumption of noninformative censoring by using a competing risks survival analysis. •This is the first community-acquired pneumonia length of stay observational study to use propensity score weighting to minimize the impact of selection bias. Background The purpose of this study was to demonstrate an antimicrobial stewardship intervention can reduce length of stay for patients admitted to hospital with community-acquired pneumonia (CAP). Methods Starting April 1, 2013, consecutive adult patients with CAP admitted to an acute care community hospital in Barrie, Ontario, Canada, were eligible for enrollment until March 31, 2015. The antimicrobial stewardship intervention was a prospective audit and feedback recommendation implemented in a stepped-wedge design across 4 wards. The primary outcome was time to hospital discharge, and secondary outcomes included time to antibiotic discontinuation and a composite outcome of 30-day readmission or all-cause mortality. The intervention effect was estimated by survival (time to discharge and antibiotic discontinuation) and logistic (30-day readmission or all-cause mortality) regression analyses. Results Complete data were available for 763 patients. The primary outcome was observed in 196 (82%) control patients and 402 (77%) intervention patients. Length of stay was reduced by 11% (95% confidence interval [CI], −9% to 35%). Time to antibiotic discontinuation was shortened by 29% (95% CI, 10%-52%). Odds ratio for 30-day readmission or all-cause mortality was 0.79 (95% CI, 0.49-1.29). Conclusions A prospective audit and feedback intervention did not significantly reduce length of hospital stay in CAP patients despite reducing overall antibiotic utilization. The purpose of this study was to demonstrate an antimicrobial stewardship intervention can reduce length of stay for patients admitted to hospital with community-acquired pneumonia (CAP). Starting April 1, 2013, consecutive adult patients with CAP admitted to an acute care community hospital in Barrie, Ontario, Canada, were eligible for enrollment until March 31, 2015. The antimicrobial stewardship intervention was a prospective audit and feedback recommendation implemented in a stepped-wedge design across 4 wards. The primary outcome was time to hospital discharge, and secondary outcomes included time to antibiotic discontinuation and a composite outcome of 30-day readmission or all-cause mortality. The intervention effect was estimated by survival (time to discharge and antibiotic discontinuation) and logistic (30-day readmission or all-cause mortality) regression analyses. Complete data were available for 763 patients. The primary outcome was observed in 196 (82%) control patients and 402 (77%) intervention patients. Length of stay was reduced by 11% (95% confidence interval [CI], −9% to 35%). Time to antibiotic discontinuation was shortened by 29% (95% CI, 10%-52%). Odds ratio for 30-day readmission or all-cause mortality was 0.79 (95% CI, 0.49-1.29). A prospective audit and feedback intervention did not significantly reduce length of hospital stay in CAP patients despite reducing overall antibiotic utilization." @default.
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• W2282499342 date "2016-05-01" @default.
• W2282499342 modified "2023-10-11" @default.
• W2282499342 title "Evaluating the impact of an antimicrobial stewardship program on the length of stay of immune-competent adult patients admitted to a hospital ward with a diagnosis of community-acquired pneumonia: A quasi-experimental study" @default.
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• W2282499342 doi "https://doi.org/10.1016/j.ajic.2015.12.026" @default.
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