Brandon Webb1, Jeff Sorensen3, Herman Post4,
Peter Jones1, Dominika Swistun1, Al Jephson3 and Nathan Dean2
Healthcare, Division of Infectious Diseases, Salt Lake City, UTUnited
States, 2Division of Pulmonary and Critical Care Medicine,
Intermountain Healthcare and the University of Utah, Salt Lake City,
UTUnited States,? 3Division of Pulmonary and Critical Care
Medicine, Intermountain Medical Center, Murray, UTUnited
States,? 4Homer Warner Center for Informatics Research,
Intermountain Healthcare, Murray, UTUnited States
Use of HCAP criteria for predicting drug-resistance in community-onset
pneumonia results in overuse of broad-spectrum antibiotics. We derived
and validated an alternative prediction tool (DRIP) (Webb AAC 2016) and
integrated it into an electronic decision support tool used in 4 U.S.
Compare DRIP to HCAP for prediction of drug-resistance and evaluate
antibiotic usage and outcomes in a prospective implementation study.
Physician use of the electronic tool and calculation of DRIP was
optional. For DRIP ≥4 anti-pseudomonal, vancomycin and
azithromycin therapy was recommended. We identified two concurrent
cohorts from 11/2014 to 10/2015: 1) cases where DRIP was calculated and
2) usual care. We compared observed rates of antibiotic use between
groups and used logistic regression to severity adjust outcomes.
DRIP and usual care comprised 894 and 324 inpatients. Drug resistance
incidence was 2.4% and 4%. Severity was higher for usual care. Compared
to HCAP, DRIP demonstrated equivalent sensitivity but better
specificity. Inadequate therapy was <1% in both groups. Relative
reduction in unnecessary broad spectrum use (25.9% p=0.008) was
observed in the DRIP group. DRIP was associated with decreased length
of stay (LOS) (coeff ? 0.147; upper 95% CI ? 0.137;
p < 0.001). Odds of in-hospital mortality did not reach
statistical significance (OR 0.643; upper 95% CI 1.04; p = 0.063).
||Usual Care %
Conclusion DRIP use
was associated with reduced unnecessary broad-spectrum antibiotic use
and LOS, without increased inadequate therapy or mortality.
DRIP versus Usual Care