Antimicrobial Stewardship Meets Transitions of Care: Defining Length of Therapy for Community-Acquired Pneumonia (CAP)

Introduction: Hospital-based antimicrobial stewardship efforts have traditionally focused on inpatient settings. Antibiotic prescribing at discharge is often an overlooked area of focus for antimicrobial stewardship programs. Discharge prescribing optimization is necessary to combat antibiotic overuse. Methods: This was an observational, retrospective cohort study at a four–adult community hospital system. Four hundred adult patients admitted with community-acquired pneumonia and discharged with antibiotics were included. The primary outcome was overall (inpatient and discharge) antibiotic length of therapy. The secondary outcome was percentage of patients discharged on a fluoroquinolone who had not received one in the hospital. Descriptive statistics were utilized. Results: The median total antibiotic length of therapy was 9.5 days (IQR 8, 11). The median inpatient and discharge antibiotic lengths of therapy were 4 days (IQR 3, 5) and 5 days (IQR 5, 7), respectively. Of the 108 patients prescribed a fluoroquinolone at discharge, 43% (46/108) had not previously received a fluoroquinolone while hospitalized. Conclusion: Both length of therapy and fluoroquinolone stewardship at discharge may represent possible antimicrobial stewardship targets in community-acquired pneumonia patients