Published guidelines for treatment of health care‐associated pneumonia (HCAP) recommend initial broad‐spectrum antibiotic therapy with appropriate de‐escalation based on culture results. Guideline recommendations are heavily based on data from intubated patients, in whom cultures are easily obtained. The approach to antibiotic de‐escalation for culture‐negative patients has not been addressed. There is no literature that describes the current standard of practice.
All patients admitted to a university medical center with a diagnosis of HCAP, as defined by use of an existing pneumonia order set in the computer order entry system, were identified over a 2‐year period, from 2007 to 2009. Antibiotics prescribed on admission, during the hospital stay, and on discharge were recorded. De‐escalation was defined as a change in the initial antibiotic therapy from broad‐ to narrow‐spectrum coverage within 14 days of the initial prescription, as judged by a licensed pharmacist. Patients with growth of a respiratory pathogen on any blood or sputum culture were considered culture positive. The Pneumonia Severity Index (PSI) was used for risk adjustment. All data were collected retrospectively.
A total of 102 patients with HCAP were included in the analysis; of those, 72% (n = 73) were culture‐negative. There were more males in the culture‐negative group; othenwise, baseline characteristics were similar between groups, as shown in Table 1, The percentage of patients whose antibiotic therapy was de‐escalated was 75% in the culture‐negative group and 77% in the culture‐positive group (P = NS). Culture‐negative patients were de‐escalated approximately 1 day earlier than culture‐positive patients (3.93 vs. 5.04 days, P = 0.03). Culture‐negative patients who were de‐escalated had a shorter length of stay, lower hospital costs, and lower mortality rates (Table 2). The most common drug choice for de‐escalation in culture‐negative patients was a respiratory fluoroquinolone (70% of patients).
Most patients with culture‐negative HCAP were safely de‐escalated to a respiratory fluoroquinolone in this small single‐center pilot study.
M. Schlueter, none; C. James, none; A. Dominguez, none; L. Tsu, none; G. Seymann, none.
To cite this abstract:Schleuter M, Tsu L, Dominguez A, James C, Seymann G. Practice Patterns for Antibiotic De‐escalation in Culture‐Negative HCAP. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 127. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/practice-patterns-for-antibiotic-deescalation-in-culturenegative-hcap/. Accessed April 10, 2020.