Authors: Dalia Chamma, Colin Busbee, Holly Mclean, Desmond Durham
Purpose/Background: The initial recommendation for empiric anaerobic coverage in aspiration pneumonia was made in the 1970s, following the identification of anaerobic isolates in multiple studies. This was likely due to poor isolation techniques and the collection of microbiologic specimens later in the course of disease, including after abscesses, necrotizing pneumonia, or empyema had developed. The purpose of this study is to evaluate whether a guideline-based educational intervention directed at prescribers reduces empiric anaerobic coverage in adults hospitalized with community-acquired pneumonia (CAP) or aspiration pneumonia without abscess or empyema, and to assess clinical outcomes, including C. difficile infections, days of therapy with empiric anaerobic coverage, and hospital length of stay.
Methodology: This study will employ a retrospective chart review of patients to evaluate provider prescribing practices pre- and post-education. The educational intervention material is a guideline-based, one-page summary of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) 2019 CAP recommendations regarding the appropriate use of empiric anaerobic coverage in aspiration pneumonia. The educational material will highlight the indications for which anaerobic coverage is appropriate, emphasize that the management of aspiration pneumonia follows standard CAP treatment, and summarize the literature that the guidelines are based upon. Educational materials will be presented to the Antimicrobial Stewardship (AMS) Committee and to appropriate service-line leadership committees for review and approval prior to electronic distribution to clinicians. Data will be collected and evaluated from Slicer Dicer reports and the hospital’s electronic records for retrospective reviews of pre- and post-intervention. The primary objective is to compare the proportion of patients with community-acquired or aspiration pneumonia who receive empiric anaerobic coverage before versus after implementation of guideline-based provider education. Secondary objectives include comparing anaerobic antibiotic days of therapy, length of stay, time to clinical stability, and C. difficile infection 30-day readmission rates in patients with aspiration or community-acquired pneumonia in the pre- and post-intervention arms.
