Background: Urinary tract infection (UTI) and community acquired pneumonia (CAP) are the two most common infections treated in hospitalized patients and are often inappropriately diagnosed. Due to myriad factors—including diagnostic uncertainty—patients are commonly inappropriately diagnosed with UTI or CAP in the emergency department (ED). Antibiotics may be continued throughout the hospitalization even if new information [...]

Background: With standard diagnostic methods, the etiologic pathogen of community acquired pneumonia (CAP) is detected in ≤ 50% hospitalized CAP patients. In our previous studies using a diagnostic “bundle”, we were able to detect etiologic pathogens in ≥ 70 % of the patients. Our bundle consisted of a nasopharyngeal swab for Biofire film array, that [...]

Background: For most infections, shorter antibiotic durations are similarly effective to longer durations but have lower risk for side effects and antibiotic resistance.1-9 Since 2019, community-acquired pneumonia (CAP) guidelines have recommended hospitalized patients with CAP be treated until clinical “stability and for no less than a total of 5 days.”10 However, randomized clinical trials have [...]

Background: Identification of pathogens causing community-acquired pneumonia (CAP) in hospitalized patients has improved with the utilization of nasopharyngeal (NP) polymerase chain reaction (PCR). Literature shows that 20-25% of pathogens are identified when using urine antigens, sputum and blood cultures, and can improve up to 70% when adding NP PCR for viruses, Staphylococcus aureus and Streptococcus [...]

Background: Community acquired pneumonia (CAP) is one of the most common causes of hospitalization in the United States1 and a frequent source of antibiotic overuse.2 Two thirds of patients hospitalized for CAP receive excess antibiotic duration, primarily from excess therapy at discharge.3 Patients living in rural areas are known to have worse health outcomes than [...]

Background: Approximately 1-2% of the U.S. population gets community-acquired pneumonia (CAP) annually in the U.S. and CAP is associated with substantial mortality, morbidity and costs.  While the incidence of CAP is well-defined, the incidence of outpatients who fail antibiotics and eventually become hospitalized is less clear.  The objective of this study was to provide real-world [...]

Background: Community-acquired pneumonia (CAP) is the most common infectious diagnosis necessitating adult hospitalization in the United States (US). Timely diagnosis of CAP is important to improve patient outcomes. However, overdiagnosis of CAP, or treatment of CAP despite inadequate signs or symptoms of CAP, may also pose a significant threat to patient safety. Potential harm of [...]

Background: Community acquired pneumonia (CAP) is commonly treated in hospitals and frequently results in antibiotic overuse. Important areas of overuse for CAP include excess treatment duration and unnecessary fluoroquinolone use. Smaller hospitals, including critical access hospitals (CAHs), often have limited resources for antibiotic stewardship compared to larger institutions which impedes stewardship efforts. After 2 years [...]

Background: Dichotomous outcomes—such as mortality—rarely capture the range of potential outcomes important to patients and clinicians. To address this limitation, the Desirability of Outcome Ranking (DOOR) score was created to rank potential outcomes from least to most desirable. Currently, there is no standardized method to develop a DOOR score and data are limited on whether [...]

Background: Urgency of and time to antibiotic administration has often been highlighted to prevent complications of community acquired pneumonia (CAP). Adult literature is mixed on whether administration of antibiotics within four hours of diagnosis of CAP reduces morbidity and mortality, however this has not been studied in pediatric patients. We evaluated whether time to antibiotics [...]