{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T20:21:34Z","timestamp":1784233294447,"version":"3.55.0"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:00:00Z","timestamp":1707868800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X2400014X_as1\"><jats:title>Objective:<\/jats:title><jats:p>The 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) aimed to reduce inappropriate inpatient antibiotic use by 20% for monitored conditions, such as community-acquired pneumonia (CAP), by 2020. We evaluated annual trends in length of therapy (LOT) in adults hospitalized with uncomplicated CAP from 2013 through 2020.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2400014X_as2\"><jats:title>Methods:<\/jats:title><jats:p>We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using <jats:italic>International Classification of Diseases Ninth and Tenth Revision<\/jats:italic> codes in MarketScan and the Centers for Medicare &amp; Medicaid Services databases. We included patients with length of stay (LOS) of 2\u201310 days, discharged home with self-care, and not rehospitalized in the 3 days following discharge. We estimated inpatient LOT based on LOS from the PINC AI Healthcare Database. The total LOT was calculated by summing estimated inpatient LOT and actual postdischarge LOT. We examined trends from 2013 to 2020 in patients with total LOT &gt;7 days, which was considered an indicator of likely excessive LOT.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2400014X_as3\"><jats:title>Results:<\/jats:title><jats:p>There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18\u201364 years and \u226565 years, respectively. From 2013 to 2020, the proportion of patients with total LOT &gt;7 days decreased by 25% (68% to 51%) among patients aged 18\u201364 years and by 27% (68%\u201350%) among patients aged \u226565 years.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X2400014X_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT &gt;7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2024.14","type":"journal-article","created":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T06:04:45Z","timestamp":1707890685000},"page":"726-732","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Length of antibiotic therapy among adults hospitalized with uncomplicated community-acquired pneumonia, 2013\u20132020"],"prefix":"10.1017","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2518-6214","authenticated-orcid":false,"given":"Natalie L.","family":"McCarthy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0757-4683","authenticated-orcid":false,"given":"James","family":"Baggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0645-4399","authenticated-orcid":false,"given":"Hannah","family":"Wolford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5783-4829","authenticated-orcid":false,"given":"Sophia V.","family":"Kazakova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1738-6443","authenticated-orcid":false,"given":"Sarah","family":"Kabbani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon K.","family":"Attell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melinda M.","family":"Neuhauser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Walker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah H.","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly M.","family":"Hatfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3267-7011","authenticated-orcid":false,"given":"Sujan","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauri A.","family":"Hicks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"S0899823X2400014X_ref5","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"S0899823X2400014X_ref10","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1093\/cid\/cis242","article-title":"Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia","volume":"54","author":"Avdic","year":"2012","journal-title":"Clin Infect Dis"},{"key":"S0899823X2400014X_ref1","unstructured":"1. US National Strategy for Combating Antibiotic-Resistant Bacteria (national strategy). Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/drugresistance\/us-activities\/national-strategy.html. Published 2014. Accessed March 21, 2023."},{"key":"S0899823X2400014X_ref9","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.cmi.2021.10.022","article-title":"Estimating daily antibiotic harms: an umbrella review with individual study meta-analysis","volume":"28","author":"Curran","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"S0899823X2400014X_ref16","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1017\/ice.2016.276","article-title":"An evaluation of antibiotic prescribing practices upon hospital discharge","volume":"38","author":"Scarpato","year":"2017","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X2400014X_ref20","unstructured":"20. Antimicrobial stewardship transition of care. Henry Ford website. https:\/\/www.henryford.com\/hcp\/academic\/ams-toc. Accessed July 11, 2023."},{"key":"S0899823X2400014X_ref18","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1093\/cid\/ciac104","article-title":"Antibiotic stewardship strategies and their association with antibiotic overuse after hospital discharge: an analysis of the reducing overuse of antibiotics at discharge (road) home framework","volume":"75","author":"Vaughn","year":"2022","journal-title":"Clin Infect Dis"},{"key":"S0899823X2400014X_ref2","first-page":"194","volume":"63","year":"2014","journal-title":"Morb Mortal Wkly Rep"},{"key":"S0899823X2400014X_ref7","doi-asserted-by":"crossref","first-page":"e212007","DOI":"10.1001\/jamanetworkopen.2021.2007","article-title":"Assessment of the appropriateness of antimicrobial use in US hospitals","volume":"4","author":"Magill","year":"2021","journal-title":"JAMA Netw Open"},{"key":"S0899823X2400014X_ref15","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1002\/jhm.2648","article-title":"Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: results of a national medication utilization evaluation","volume":"11","author":"Madaras-Kelly","year":"2016","journal-title":"J Hosp Med"},{"key":"S0899823X2400014X_ref21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1177\/0885713X9701200404","article-title":"Community-acquired pneumonia: can it be defined with claims data?","volume":"12","author":"Whittle","year":"1997","journal-title":"Am J Med Qual"},{"key":"S0899823X2400014X_ref3","unstructured":"3. Core elements of hospital antibiotic stewardship programs. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/antibiotic-use\/core-elements\/hospital.html. Published 2019. Accessed July 11, 2023."},{"key":"S0899823X2400014X_ref8","doi-asserted-by":"crossref","first-page":"153","DOI":"10.7326\/M18-3640","article-title":"Excess antibiotic treatment duration and adverse events in patients hospitalized with pneumonia: a multihospital cohort study","volume":"171","author":"Vaughn","year":"2019","journal-title":"Ann Intern Med"},{"key":"S0899823X2400014X_ref13","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1001\/jamainternmed.2016.3633","article-title":"Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial","volume":"176","author":"Uranga","year":"2016","journal-title":"JAMA Intern Med"},{"key":"S0899823X2400014X_ref14","doi-asserted-by":"crossref","first-page":"106189","DOI":"10.1016\/j.ijantimicag.2020.106189","article-title":"A pharmacist-led prospective antibiotic stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa","volume":"56","author":"van den Bergh","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"S0899823X2400014X_ref22","first-page":"2333392820939801","article-title":"Pneumonia hospitalization coding changes associated with transition from the 9th to 10th revision of International Classification of Diseases.","volume":"7","author":"Smithee","year":"2020","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"S0899823X2400014X_ref6","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1093\/cid\/cix986","article-title":"Duration of antibiotic use among adults with uncomplicated community-acquired pneumonia requiring hospitalization in the United States","volume":"66","author":"Yi","year":"2018","journal-title":"Clin Infect Dis"},{"key":"S0899823X2400014X_ref11","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1017\/ice.2016.165","article-title":"Sustained impact of an antibiotic stewardship intervention for community-acquired pneumonia","volume":"37","author":"Li","year":"2016","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0899823X2400014X_ref12","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1093\/jac\/dky021","article-title":"A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia","volume":"73","author":"Foolad","year":"2018","journal-title":"J Antimicrob Chemother"},{"key":"S0899823X2400014X_ref17","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1016\/j.ajic.2021.11.016","article-title":"Reducing overuse of antibiotics at discharge home: a single-center mixed-methods pilot study","volume":"50","author":"Giesler","year":"2022","journal-title":"Am J Infect Control"},{"key":"S0899823X2400014X_ref4","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1086\/511159","article-title":"Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults","volume":"2","author":"Mandell","year":"2007","journal-title":"Clin Infect Dis"},{"key":"S0899823X2400014X_ref19","doi-asserted-by":"crossref","first-page":"e2211331","DOI":"10.1001\/jamanetworkopen.2022.11331","article-title":"Pharmacist-driven transitions of care practice model for prescribing oral antimicrobials at hospital discharge","volume":"5","author":"Mercuro","year":"2022","journal-title":"JAMA Netw Open"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X2400014X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T08:33:48Z","timestamp":1715934828000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X2400014X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,14]]},"references-count":22,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["S0899823X2400014X"],"URL":"https:\/\/doi.org\/10.1017\/ice.2024.14","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,14]]},"assertion":[{"value":"\u00a9 The Society for Healthcare Epidemiology of America, 2024","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is a work of the US Government and is not subject to copyright protection within the United States. To the extent this work is subject to copyright outside of the United States, the US Government retains a paidup, nonexclusive, irrevocable worldwide licence to reproduce, prepare derivative works, distribute copies to the public and display publicly the Contribution, and to permit others to do so. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}