Is More Always Better? Effect of a Combination Pseudomonas Antibiogram on Levofloxacin Use and Patient Outcomes for Pneumonia in a Large Community Hospital
Abstract
Abstract Background Evidence suggests that combination therapy for Pseudomonas pneumonia only provides mortality benefit in critically ill patients. In November 2015, the Antimicrobial Stewardship Subcommittee at Baptist Memorial Hospital-Memphis (BMH-Memphis) developed a combination Pseudomonasantibiogram and guideline, based on local susceptibilities, for critically ill patients with Hospital Acquired Pneumonia (HAP), Health Care Associated Pneumonia (HCAP), or Ventilator Associated Pneumonia (VAP). Methods This is a single center, retrospective study evaluating patients admitted to the BMH-Memphis medical intensive care unit (MICU) and surgical intensive care unit (SICU) with a diagnosis-related group (DRG) code for HAP, HCAP, or VAP.The primary objective of this study was to compare levofloxacin days of therapy per 1000 patient-days (DOT/1000 patient-days) before and after implementation of the combination Pseudomonas antibiogram guideline at BMH-Memphis. Secondary objectives included a comparison of individual levofloxacin orders, 30-day mortality, hospital length of stay (LOS), ICU LOS, 90-day incidence of extended spectrum β-lactamases (ESBLs), and 30-day readmission rates and incidence of Clostridium difficile. Adverse events including acute kidney injury and QTc prolongation were also evaluated pre- and post-implementation of the guideline. Results A total 150 patients were included in this study to meet power for the primary objective. Levofloxacin DOT/1000…
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