{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:52:21Z","timestamp":1785775941207,"version":"3.56.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence suggests a 3\u2010day total duration and early transition to oral therapy is safe in hospitalized patients with community acquired pneumonia (CAP)\u2014though such care is not standard in the United States. To implement these evidence\u2010based practices, a multidisciplinary group led by a hospitalist and antimicrobial stewardship updated an order set targeted at non\u2010intensive care unit (ICU) patients with CAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Here, we assess the impact of our intervention on diagnostic and antibiotic treatment measures and associated clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective, pre\/post, observational quality improvement study of non\u2010ICU inpatients with CAP admitted to a single academic medical center. The order set defaulted to 1 day of ceftriaxone without empiric atypical coverage for most patients, automatic de\u2010escalation to oral amoxicillin on Day 2, a shortened total antibiotic duration of 3 days, and appropriate laboratory utilization. Primary outcomes were antibiotic duration and azithromycin use. Clinical outcomes were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The pre (1\/2019\u201312\/2021,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009777) and post (1\/2022\u201312\/2023,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091416) intervention periods were compared using generalized linear models and interrupted time series adjusted for known confounders. After implementation of the orderset, total antibiotic duration (6\u20135 days, adjusted rate ratio: 0.92, 95% confidence interval [CI]: 0.89\u20130.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) and azithromycin use (62.4% [485\/777] to 39.4% [558\/1416], adjusted odds ratio: 0.39, 95% CI: 0.33\u20130.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01) were significantly lower. Clinical outcomes were not significantly different postintervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An order set backed by stewardship and hospitalists improves appropriate antibiotic use, showing that ongoing data\u2010driven refinements can sustain stewardship and support the safety of shorter, narrower antibiotics for CAP in real\u2010world care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70283","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T06:48:45Z","timestamp":1770792525000},"page":"890-897","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Streamlining antibiotic use in community acquired pneumonia: A quality improvement initiative"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7057-0728","authenticated-orcid":false,"given":"Claire E.","family":"Ciarkowski","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of General Internal Medicine University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Utah Health Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Imlay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases University of Utah Salt Lake City Utah USA"},{"name":"Veteran's Affairs Salt Lake City Health Care System Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaorong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Epidemiology University of Utah Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christy L.","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4362-7842","authenticated-orcid":false,"given":"Valerie M.","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of General Internal Medicine University of Utah Salt Lake City Utah USA"},{"name":"Veteran's Affairs Salt Lake City Health Care System Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Spivak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases University of Utah Salt Lake City Utah USA"},{"name":"Veteran's Affairs Salt Lake City Health Care System Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-018-0787-2"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix647"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13965"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.0077"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M23-2505"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3640"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaa497"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00313-5"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7554.1355"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1581ST"},{"issue":"9","key":"e_1_2_6_13_1","first-page":"004418","article-title":"Empiric antibiotic coverage of atypical pathogens for community\u2010acquired pneumonia in hospitalized adults","volume":"2012","author":"Eliakim\u2010Raz N","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2024.453"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(23)00412-5"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.4887"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiae639"},{"issue":"1","key":"e_1_2_6_18_1","first-page":"4","article-title":"Management of community\u2010acquired pneumonia in adults: 2016 guideline update from the Dutch Working Party on antibiotic policy (SWAB) and dUtch Association of Chest Physicians (NVALT)","volume":"76","author":"Wiersinga WJ","year":"2018","journal-title":"Neth J Med"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1406330"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix549"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.17843"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00868-3"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.70283","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jhm.70283","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jhm.70283","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:23:13Z","timestamp":1785774193000},"score":1,"resource":{"primary":{"URL":"https:\/\/shmpublications.onlinelibrary.wiley.com\/doi\/10.1002\/jhm.70283"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,10]]},"references-count":22,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/jhm.70283"],"URL":"https:\/\/doi.org\/10.1002\/jhm.70283","archive":["Portico"],"relation":{},"ISSN":["1553-5592","1553-5606"],"issn-type":[{"value":"1553-5592","type":"print"},{"value":"1553-5606","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,10]]},"assertion":[{"value":"2025-05-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}