Objective: 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. Methods: We conducted a retrospective cohort study among adults with a primary diagnosis of bacterial or unspecified pneumonia using International Classification of Diseases Ninth and Tenth Revision codes in MarketScan and the Centers for Medicare & Medicaid Services databases. We included patients with length of stay (LOS) of 2–10 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 >7 days, which was considered an indicator of likely excessive LOT. Results: There were 44,976 and 400,928 uncomplicated CAP hospitalizations among patients aged 18–64 years and ≥65 years, respectively. From 2013 to 2020, the proportion of patients with total LOT >7 days decreased by 25% (68% to 51%) among patients aged 18–64 years and by 27% (68%–50%) among patients aged ≥65 years. Conclusions: Although likely excessive LOT for uncomplicated CAP patients decreased since 2013, the proportion of patients treated with LOT >7 days still exceeded 50% in 2020. Antibiotic stewardship programs should continue to pursue interventions to reduce likely excessive LOT for common infections.

中文翻译：

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2013-2020 年因单纯性社区获得性肺炎住院的成人抗生素治疗时长

目标：2014 年美国抗击抗生素耐药性细菌国家战略 (CARB) 旨在到 2020 年将社区获得性肺炎 (CAP) 等受监测情况下住院患者不适当抗生素使用减少 20%。我们评估了住院时长的年度趋势对 2013 年至 2020 年因无并发症 CAP 住院的成人进行治疗 (LOT)。 方法：我们对初步诊断为细菌性或未特指肺炎的成人进行了一项回顾性队列研究，使用国际疾病分类第九版和第十版修订版MarketScan 以及医疗保险和医疗补助服务中心数据库中的代码。我们纳入了住院时间 (LOS) 为 2-10 天、出院回家进行自我护理、出院后 3 天内未再次住院的患者。我们根据 PINC AI 医疗保健数据库中的 LOS 估算了住院患者 LOT。总 LOT 是通过将估计的住院 LOT 与实际出院后 LOT 相加来计算的。我们研究了 2013 年至 2020 年总 LOT > 7 天的患者的趋势，这被认为是 LOT 可能过多的一个指标。结果：18-64 岁和 65 岁以上的患者中，分别有 44,976 名和 400,928 名无并发症 CAP 住院患者。2013年至2020年，18-64岁患者中总LOT>7天的患者比例下降了25%（68%至51%），年龄≥65岁患者中下降了27%（68%至50%） 。结论：尽管自 2013 年以来，无并发症的 CAP 患者可能出现的 LOT 过多的情况有所减少，但到 2020 年，接受 LOT 治疗 > 7 天的患者比例仍超过 50%。抗生素管理计划应继续采取干预措施，以减少常见感染可能出现的 LOT 过多的情况。