2026 Southeastern Residency Conference

Title: Antimicrobial Prescribing Practices for Community-Acquired Pneumonia (CAP) in a Community, Teaching Health System
Authors: Anna Collins, Chris Whitman, Rachel L. Foster, Jeff Bruni, Cherie Abernathy
Background: Community-acquired pneumonia (CAP) is a major U.S. health concern, particularly in adults aged 65 years and older. Many antibiotic prescriptions may deviate from guidelines, with frequent overuse of broad-spectrum antibiotics, failure to de-escalate therapy, and prolonged durations of therapy. This project aims to evaluate prescribing patterns for the treatment of community-acquired pneumonia (CAP) within Infirmary Health (IH). Antibiotic selection and treatment durations were compared to current national guideline recommendations to determine guideline concordance and appropriateness of current inpatient CAP treatment within IH. These findings will support data-driven antimicrobial stewardship efforts by identifying specific areas for improvement in prescribing practices to enhance patient care and reduce antimicrobial resistance within the community.
Methods: This study is a retrospective chart review of adult inpatients who were diagnosed with and treated for CAP within IH in 2024. International Classification of Diseases (ICD-10) codes and Diagnosis Related Groups for CAP were used to obtain patients. Patients were then randomized and 270 patients were reviewed. The first admission in 2024 was included per patient. The primary outcome was to determine the prevalence of Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guideline-concordant CAP treatment according to disease severity and risk factors. The primary outcome was assessed at three different timepoints: day one of CAP therapy, day two of CAP therapy, and the last day of inpatient CAP therapy. Secondary outcomes included comparing baseline characteristics, length of stay, 30-day readmission, and 30-day all-cause mortality between patients treated according to IDSA/ATS guidelines and those that were not. Patients were excluded if they received less than 72 hours of antibiotics for CAP treatment, had a concurrent infection requiring a longer length of therapy or alternative drug selection, any hospital-acquired or ventilator-associated pneumonia, had a diagnosis of cystic fibrosis or other advanced structural lung disease, had conditions predisposing to noncommunity-acquired pathogens, patients who left against medical advice, expired, or transitioned to hospice during the CAP treatment course, history of lung transplant, pregnant or breastfeeding, incarcerated, those transferring from an outside hospital, and patients with a pneumonia-related complication.
Results: There were 2,576 unique patients identified. Of these, 270 charts were reviewed and 130 patients were included in the final analysis. The median age was 71 and 68 years in the guideline concordant and discordant groups, respectively, and baseline characteristics were similar between the two groups. Recent healthcare exposure in the prior 90 days was more common among patients receiving guideline-discordant therapy: 19% had received intravenous (IV) antibiotics compared with 2% in the guideline-concordant group, and 29% had a hospital admission compared with 9%, respectively. Overall, 64% of patients received guideline discordant therapy. Rates of guideline discordance were similar across the three timepoints assessed. Notably, 36% of patients received empiric MRSA or Pseudomonas therapy when it was not indicated. The antibiotic lengths of therapy were 8 and 9 days in the guideline concordant and discordant groups, respectively. There were no significant differences in length of stay, 30-day readmission, or 30-day mortality between the two groups.
Conclusions: The majority of patients in this population received guideline discordant therapy for the treatment of CAP, with trends toward overly broad antibiotic selection and longer than recommended durations of therapy. Patients receiving guideline discordant therapy were more likely to have an admission and receipt of IV antibiotics in the prior 90 days. These findings highlight an opportunity to optimize antibiotic selection and duration of therapy for CAP treatment within Infirmary Health.