Evaluating the Impact of an Antimicrobial Stewardship Program on the Length of Stay of Immune-Competent Adult Patients Admitted to a Hospital Ward With a Diagnosis of Community-Acquired Pneumonia: A Pragmatic Clinical Trial
Bibliographic record
Abstract
Background. Pneumonia accounts for a large proportion of hospital admissions and antibiotic utilization. Physician adherence with evidence-based pneumonia management guidelines is poor. Antimicrobial stewardship programs (ASP) are an effective intervention to mitigate against unwarranted variation from these guidelines. Despite this benefit, ASP have not been shown to reduce the length of stay of hospitalized patients with pneumonia. Methods. Pragmatic clinical study in a 339-bed hospital located in Ontario, Canada. Starting on 1 April 2013 and ending 31 March 2015, all consecutive immune-competent adult patients (>18 years old) admitted to hospital with pneumonia were eligible for enrollment. The ASP intervention was a prospective audit and feedback recommendation implemented in a non-randomized stepped wedge design across 4 wards and modeled as a time-dependent variable. The primary outcome was time to hospital discharge and secondary outcomes included time to antibiotic discontinuation and composite of 30-day re-admission or all-cause mortality. Effect on outcomes was evaluated using survival (time to discharge and antibiotic discontinuation) and logistic (30-day re-admission and all-cause mortality) regression analyses. Results. Complete data was available for 763 patients. Primary outcome was observed in 196 (82%) control and 402 (77%) intervention patients. Competing risks survival analysis of the primary outcome demonstrated a sub-distribution hazard ratio (SHR) of 1.08 (95% CI 0.80–1.46) for patients exposed to the intervention. There was significant effect on days and duration of antimicrobial therapy (SHR 1.29 [95% CI 1.10–1.52] and 1.65 [95% CI 1.42–1.93], respectively). A SHR >1 should be interpreted as a reduction in time to hospital discharge or antibiotic discontinuation. There was no significant effect on 30-day re-admission or all-cause mortality (OR 0.79 [95% CI 0.49–1.29]). Conclusion. A prospective audit and feedback ASP intervention did not reduce length of hospital stay in patients with pneumonia despite reducing overall antibiotic utilization. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.016 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".