Cleveland Clinic has received a $2.5 million grant from the Agency of Healthcare Research and Quality (AHRQ) to conduct a multicenter clinical trial to evaluate ways to reduce the use of broad-spectrum antibiotics in adult patients with community-acquired pneumonia.
The five-year grant, led by Michael Rothberg, M.D., vice chair of Cleveland Clinic Community Care, and Abhishek Deshpande, M.D., Ph.D., a staff physician in the Center for Value-Based Care Research, will be the largest randomized trial to determine the impact of rapid diagnostic testing on antibiotic use in adult patients with community-acquired pneumonia. Pneumonia is an infection of one or both lungs that can cause mild to severe illness. Community-acquired pneumonia is the most common type of pneumonia.
“Community-acquired pneumonia is a leading cause of hospitalizations and inpatient morbidity and mortality in the United States,” said Dr. Rothberg. “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 categorized based on where an infection was acquired and the type of germ that caused the infection. It is most commonly caused by bacteria, viruses or fungi. Treatment for pneumonia should be determined by the cause: antibiotics for bacterial pneumonia, antiviral drugs for influenza and COVID-19, and antifungal medication for fungi. Because most patients are not tested for the cause, they are usually treated with antibiotics, often for long periods of time.
This trial will test two approaches to limiting the use of antibiotics in hospitalized patients: routine use of rapid diagnostic testing at the time of hospital admission, and pharmacist-led de-escalation which involves stopping or changing the antibiotics to target a specific bacteria after 48 hours for clinically stable patients who test negative for bacterial pneumonia.
Knowing what type of pathogen is causing a patient’s pneumonia could allow physicians to begin with more targeted therapy, avoiding unnecessary antibiotics. Just as important, understanding when patients do not have a resistant bacteria could allow for them to receive standard antibiotic therapy for most of their hospital stay, avoiding complications that come with stronger antibiotics.
“Our overall goal is to improve antimicrobial prescribing for patients with community-acquired pneumonia,” said Dr. Deshpande. “Specifically, knowledge gained from this trial will allow physicians to limit the use of broad-spectrum antimicrobials and initiate targeted therapy.”
Approximately 1 million adults in the United States are hospitalized each year for pneumonia and 50,000 of those die from the disease. Receiving all recommended vaccinations is the best way to prevent pneumonia. Additionally, practicing proper hand hygiene, avoiding smoking, and maintaining a healthy immune system can help protect against infection.