Increased Utilization of Guideline‐Recommended Antibiotics for Health Care–Associated Pneumonia Following an Educational Intervention

Background:

In 2005, the Infectious Diseases Society of America and the American Thoracic Society published guidelines regarding treatment of health care–associated pneumonia (HCAP). These guidelines recommend MRSA coverage as well as 2 antipseudo‐monal antibiotics for patients with HCAP. In December 2007, an electronic survey with hypothetical HCAP cases was sent to 228 UCSD physicians most likely to care for inpatients with pneumonia to assess prescribing patterns. Performance was poor, with respondents choosing antibiotic regimens consistent with guidelines only 21% of the time. This was followed by a brief, 1‐screen educational intervention explaining criteria for HCAP and reviewing appropriate guideline‐recommended antibiotics for HCAP. This study assessed whether the educational intervention raised awareness of HCAP enough to influence antibiotic prescription patterns.

Methods:

We retrospectively reviewed the antibiotics selected within 48 hours of admission for all patients admitted at UCSD with a diagnosis of pneumonia (ICD‐9 codes 480–486 and 487.0) between September 2007 and March 2008. Antibiotics were reviewed and classified as meeting HCAP criteria (MRSA coverage and 2 antipseudomonal antibiotics), community‐acquired pneumonia (CAP) criteria (respiratory fluoroquinolone, or a combination of a third‐generation cephalosporin plus azithromycin or doxycycline), or other. Antibiotic selection in the preintervention period (September–November 2007) was compared to antibiotic selection in the postinterven‐tion period (January–March 2008) using the chi‐square test.

Results:

A total of 584 cases of pneumonia were identified during the study period. The percentage of patients treated with guideline‐recommended antibiotics for HCAP increased from 23% in September–November 2007 to 32% in January–March 2008 (P = 0,03). The percentage of patients treated with CAP antibiotics decreased from 41% to 34% (P = 0.13). The percentage of patients prescribed at least 1 antipseudomonal antibiotic increased from 49% to 57% (P = 0.08).

Conclusions:

Utilization of guideline‐recommended antibiotics for HCAP increased after administration of an educational survey. Although it is a widely held tenet that educational interventions are not sufficient motivators of quality improvement and that changes require more systematic interventions, these data suggest that our brief, targeted educational intervention may have played a role in increasing awareness of HCAP and altering antibiotic prescription patterns.

Author Disclosure:

B. Huang, UCSD Medical Center, employment; G. Seymann, UCSD Medical Center, employment.