Ciprofloxacin Automatic Stop on Pneumonia Pathway Orders: Impact on Clinical Outcomes

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Background: Pneumonia patients at risk for multi-drug resistant bacteria, including Pseudomonas aeruginosa, are often prescribed ciprofloxacin in combination with an anti-pseudomonal beta lactam. As part of the antibiotic stewardship program a 24-hour automatic stop (AS) for ciprofloxacin was added to the pneumonia pathway orders on 6/1/12. We hypothesized that the change would not lead to any deterioration in time to clinical stability.

Methods: We conducted a retrospective review of records for patients that followed pneumonia pathway orders during the no automatic stop date (NSD)period and after the 24-hour AS start date to determine if there was any difference in time to clinical stability. A diagnosis of pneumonia was confirmed with a new infiltrate on chest radiograph in combination with at least 2 clinical symptoms of pneumonia. Patient baseline characteristics and treatment outcomes were collected from the medical record. Time to clinical stability was defined as the time from admission to the day of hospitalization when temperature ≤37.8°C, heart rate ≤ 100 beats per minute, respiratory rate ≤ 24 breaths per minute, systolic blood pressure ≥ 90 mmHg, and arterial oxygen saturation ≥90%. Secondary outcomes included length of stay, time to oral therapy, all cause in-hospital mortality, positive Clostridium difficile toxin, 30 day pneumonia readmission, and re-initiation of ciprofloxacin therapy. Survival analyses for time to clinical stability included Kaplan Meier analysis and a Cox proportional hazard model.

Results: 87charts were reviewed. A total of 29 pts in NSD and 30 pts in AS met the inclusion criteria. Baseline demographics were comparable in NSD and AS: Male/Female 17/12 and 16/14, mean age 70.1 and 72.2 years. The majority of patients in both groups were pneumonia severity index class 4 and 5. Survival was similar between groups on Kaplan Meier analysis and Cox proportional hazard regression.

Conclusion: The addition of an automatic one-day stop for ciprofloxacin does not affect time to clinical stability in pneumonia pathway patients.


Presented at the Infectious Diseases Society of America Meeting in San Francisco, California, October 4, 2013.

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