# Reducing Antimicrobial Overuse Through Targeted Therapy for Patients with Community-Acquired Pneumonia

> **NIH AHRQ R01** · CLEVELAND CLINIC FOUNDATION · 2021 · $499,999

## Abstract

Project Summary/Abstract
Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and inpatient morbidity and
mortality in the United States. However, the etiological diagnosis of CAP is challenging as >75% of cultures are
negative and a causative pathogen cannot be identified. The ATS/IDSA guidelines recommend that extended
spectrum empiric antimicrobial therapy be limited to adult patients with risk factors for resistant pathogens.
However, in the face of negative cultures and diagnostic uncertainty, clinicians are often uncomfortable de-
escalating therapy, because narrowing treatment could result in inadequate coverage. The prolongation of
empiric treatment hampers antimicrobial stewardship efforts and encourages the development of antimicrobial
resistance. Our overall goal is to improve antimicrobial prescribing for patients with CAP by emphasizing
pathogen-directed therapy. An accurate pathogenic diagnosis could contribute to antimicrobial stewardship in 2
ways: 1) by allowing for initial narrow-spectrum therapy and 2) by providing confidence when de-escalating
therapy following negative cultures. Rapid diagnostic assays have the potential to provide accurate results
within hours and thereby reduce the duration of exposure to extended spectrum empiric therapy. Multiple
observational studies have demonstrated that use of molecular diagnostic assays is associated with favorable
outcomes including a reduction in the total duration of antimicrobial use and length of stay in the hospital. The
most recent antimicrobial stewardship implementation guidelines recommend the use of rapid viral testing for
respiratory pathogens as a means to reduce the use of inappropriate antibiotics. However, these
recommendations are based on low quality evidence and it is unknown whether more widespread early
diagnostic testing could reduce the use of broad-spectrum antibiotics and/or prompt initiation of antiviral
therapy. De-escalation following negative bacterial cultures is another antimicrobial stewardship target. While
most de-escalation follows identification of a susceptible pathogen, the ATS/IDSA guidelines also recommend
de-escalation at 48 hours if cultures are negative. However, these recommendations are also based on
observational studies. We propose a large, multicenter 2 X 2 factorial cluster randomized controlled trial to test
both approaches to reducing the use of broad-spectrum antibiotics in patients with CAP: a) routine use of rapid
diagnostic testing at the time of admission and b) pharmacist-led de-escalation after 48 hours for clinically
stable patients with negative cultures. Our study will be the largest randomized trial to determine the impact of
rapid diagnostic testing on antimicrobial stewardship and patient outcomes. Our randomized trial design will
allow us to establish causality and determine whether broad spectrum antibiotics can be safely de-escalated in
stable patients. Findings from our proposed trials will gener...

## Key facts

- **NIH application ID:** 10340313
- **Project number:** 1R01HS028633-01
- **Recipient organization:** CLEVELAND CLINIC FOUNDATION
- **Principal Investigator:** ABHISHEK DESHPANDE
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $499,999
- **Award type:** 1
- **Project period:** 2021-09-30 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10340313

## Citation

> US National Institutes of Health, RePORTER application 10340313, Reducing Antimicrobial Overuse Through Targeted Therapy for Patients with Community-Acquired Pneumonia (1R01HS028633-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10340313. Licensed CC0.

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