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Using the Antibiotic Intensity Score to Evaluate Antibiotic Use in Hospitalized Patients With Community-Acquired Pneumonia With Known Versus Unknown Etiology: Results From the Community-Acquired Pneumonia Organization International Cohort Study

Year: 2016

Type: article

Abstract: Background. In community-acquired pneumonia (CAP) patients with an identified pathogen, broad-spectrum antibiotic therapy should narrow to a pathogen-directed therapy. This leads to less antibiotic exposure when compared to patients with CAP of unknown etiology. Less exposure may decrease the risk of toxicity and collateral damage. The antibiotic intensity score combines the number of days of each antibiotic with the antibiotic spectrum to calculate a score that defines antibiotic exposure. The objective of this study was to use the antibiotic intensity score to define if patients with CAP of known etiology are exposed to fewer antibiotics compared to patients with unknown etiology. Methods. This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. The intensity score was calculated as the sum of the number of days of each antibiotic multiplied by the antibiotic spectrum. The spectrum was translated into numeric values from 1 to 9 with increasing spectrum. Results. A total of 772 patients were included in the study, 401 with an unknown etiology and 371 with a known etiology. The median antibiotic intensity score (IQR) was 60 (54) for those with a known etiology, and 55 (48) for those with an unknown etiology (P = 0.33). Conclusion. This study indicates that there is no difference in antibiotic exposure for patients with CAP when a pathogen is identified or not. Our data suggest that current clinical practice is to manage patients with broad-spectrum antibiotics without performing pathogen-directed therapy once an etiology of CAP has been identified. The influence of an effective antimicrobial stewardship program should impact this practice. Disclosures. All authors: No reported disclosures

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.937