{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:31:53Z","timestamp":1784809913527,"version":"3.55.0"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"unspecified","delay-in-days":226,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2732494X25101009_as1\">\n\t    <jats:title>Objective:<\/jats:title>\n\t    <jats:p>This before\u2013after study aimed to evaluate whether an order-set intervention would improve CABP-guideline concordance among outpatients.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25101009_as2\">\n\t    <jats:title>Setting:<\/jats:title>\n\t    <jats:p>This study included adult patients presenting to outpatient clinics (<jats:italic>n<\/jats:italic> = 92) and urgent care centers (<jats:italic>n<\/jats:italic> = 39) within a community-based health system without a formal outpatient antibiotic stewardship program (ASP).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25101009_as3\">\n\t    <jats:title>Intervention:<\/jats:title>\n\t    <jats:p>The intervention consisted of an antibiotic order-set and awareness campaign. Patient encounters were identified via CABP ICD-10 codes and IDSA-relevant patient comorbidities (chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia) were extracted from the electronic health record. Primary outcome was to describe the proportion of patients receiving concordant therapy per IDSA guideline and local antibiogram in a pre- (May 2023 \u2013 April 2024) and post-intervention period (May 2024 \u2013 December 2024).<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25101009_as4\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>Baseline and intervention antibiotic concordance rate was 33.3% (1,467\/4,401 encounters) and 28.0% (1,388\/4,954 encounters), respectively. Among patients with no comorbidity, monotherapy prescriptions (concordant and discordant) decreased post-intervention and were replaced by higher levels of combination therapy (15% increase), albeit all discordant due to lack of comorbidities. Among patients with comorbidities, combination antibiotics increased by 12% post-intervention, driven by concordant prescriptions including amoxicillin\/clavulanate plus azithromycin while the most frequently prescribed discordant combination was amoxicillin plus azithromycin. Trends were similar in primary care and urgent care centers.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25101009_as5\">\n\t    <jats:title>Conclusions:<\/jats:title>\n\t    <jats:p>A stewardship intervention, including an order-set and awareness campaign improved the selection of combination therapy for appropriate patients but did not improve overall guideline concordance. For health systems without a dedicated outpatient ASP, these data will help bolster stewardship efforts towards more effective strategies.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/ash.2025.10100","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T06:06:38Z","timestamp":1755237998000},"source":"Crossref","is-referenced-by-count":1,"title":["An antibiotic stewardship initiative focused on community-acquired bacterial pneumonia (CABP) in outpatient clinics and urgent care centers: a 2023\u20132024 community health system experience"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6268-0924","authenticated-orcid":false,"given":"Tomefa E.","family":"Asempa","sequence":"first","affiliation":[{"name":"Hartford Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Ackley","sequence":"additional","affiliation":[{"name":"Hartford Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin E.","family":"Linder","sequence":"additional","affiliation":[{"name":"Hartford Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara D.","family":"Riddle","sequence":"additional","affiliation":[{"name":"GoHealth Urgent Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Walsh","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Medical Group"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David P.","family":"Nicolau","sequence":"additional","affiliation":[{"name":"Hartford Hospital"},{"name":"Hartford Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"S2732494X25101009_ref1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"S2732494X25101009_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520270048030"},{"key":"S2732494X25101009_ref14","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1581ST"},{"key":"S2732494X25101009_ref16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix407"},{"key":"S2732494X25101009_ref23","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2021.228"},{"key":"S2732494X25101009_ref24","doi-asserted-by":"publisher","DOI":"10.3201\/eid2012.140331"},{"key":"S2732494X25101009_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw118"},{"key":"S2732494X25101009_ref21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1945-1474.2006.tb00601.x"},{"key":"S2732494X25101009_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa667"},{"key":"S2732494X25101009_ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-014-0194-5"},{"key":"S2732494X25101009_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9356"},{"key":"S2732494X25101009_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3047"},{"key":"S2732494X25101009_ref8","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr6506a1"},{"key":"S2732494X25101009_ref4","doi-asserted-by":"publisher","DOI":"10.1086\/678057"},{"key":"S2732494X25101009_ref9","doi-asserted-by":"publisher","DOI":"10.1086\/322627"},{"key":"S2732494X25101009_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofae336"},{"key":"S2732494X25101009_ref5","doi-asserted-by":"publisher","DOI":"10.2147\/IDR.S290835"},{"key":"S2732494X25101009_ref17","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2024.35"},{"key":"S2732494X25101009_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae604"},{"key":"S2732494X25101009_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy902"},{"key":"S2732494X25101009_ref25","unstructured":"25. Centers for Disease Control and Prevention website. Weekly US Influenza Surveillance Report: Key Updates for Week 7, ending February 15. 2025. https:\/\/www.cdc.gov\/fluview\/surveillance\/2025-week-06.html. Published Feb 15 2025. Accessed February 24, 2025."},{"key":"S2732494X25101009_ref26","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7401a1"},{"key":"S2732494X25101009_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03672.x"},{"key":"S2732494X25101009_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2023.152"},{"key":"S2732494X25101009_ref12","unstructured":"12. The Joint Commission. R3 report issue 23: antimicrobial stewardship in ambulatory health care. Accessed February 18, 2025. https:\/\/www.jointcommission.org\/standards\/r3-report\/r3-report-issue-23-antimicrobial-stewardship-in-ambulatory-health-care\/"},{"key":"S2732494X25101009_ref6","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.3205"}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X25101009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T06:06:40Z","timestamp":1755238000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X25101009\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S2732494X25101009"],"URL":"https:\/\/doi.org\/10.1017\/ash.2025.10100","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e185"}}