The Agency of Healthcare Research and Quality has granted $2.5 million to Cleveland Clinic to lead a clinical trial that studies ways to cut the use of broad-spectrum antibiotics among patients with community-acquired pneumonia, the health system said Dec. 9.
"Community-acquired pneumonia is a leading cause of hospitalizations and inpatient morbidity and mortality in the United States," said Michael Rothberg, MD, vice chair of Cleveland Clinic Community Care and co-lead of the five-year grant. "However, determining the type of pathogen that caused the infection can be challenging, leading to the prolonged use of powerful antibiotics. Most patients do not need these drugs, which can have serious side effects and promote future antibiotic resistance."
Pneumonia is typically caused by either bacteria, viruses, or fungi; however, patients are often not tested for the type of germ that caused the infection and are treated with antibiotics. While antibiotics are meant for bacterial pneumonia, antivirals should be given for viruses and antifungal medications for infections caused by fungi. By identifying the type of pathogen causing a patient's pneumonia, care teams can avoid unnecessary antibiotics and initiate targeted therapy sooner, according to a news release.
The multicenter trial will test two approaches to reduce the use of antibiotics in hospitalized patients. The first is the routine use of rapid diagnostic testing upon admission to identify the source of the infection. The second is a "pharmacist-led de-escalation, which involves stopping or altering the antibiotics to target a specific bacteria after 48 hours for clinically stable patients who test negative for bacterial pneumonia."