P-2031. Implementation of a Quality Improvement Model for Evaluation of Community-acquired Pneumonia Management in the Coccidioidal Endemic Region

TL;DR

This study implemented a quality improvement model to evaluate pneumonia treatment practices in a region where a fungal infection is common.

Contribution

The paper introduces a continuous quality improvement model for managing pneumonia in a coccidioidomycosis-endemic area.

Findings

Only 56% of patients with pneumonia were tested for coccidioidomycosis as recommended.

Most patients diagnosed with coccidioidomycosis still received antibacterial treatment.

Only 67% of patients received guideline-recommended antibiotic therapy for pneumonia.

Abstract

Coccidioidomycosis (CM) is an infection caused by the fungal pathogens Coccidioides and is endemic in the southwestern United States. It is estimated that approximately 25% of cases of community-acquired pneumonia (CAP) in this region are due to Coccidioides, presenting unique challenges to antimicrobial stewardship programs there. The objective of this project was to establish a continuous quality improvement model to collect information regarding CAP management practices at a major medical center in Arizona.

A daily reporting system was established to identify all adult patients admitted to Banner University Medical Center-Tucson that were coded for pneumonia with ICD-10 code J18.9 from December 1, 2024 – April 18, 2025. Patient demographic information as well as CM serologic testing and antimicrobial prescription patterns were collected.

225 patients were included for analysis. 56% (126/225) patients had CM serologic testing performed with 71.4% (40/56) patients having CM testing performed in the intensive care unit. Monthly trends demonstrated variable rates of CM testing and CM positivity. Of the 126 patients who had CM testing performed, 9 (7.1%) had positive results, all being returned while hospitalized. Two patients were started on antifungals, while all 9 patients received a full course of antibacterials for CAP. Only 67.1% (151/225) of all patients received CAP-guideline recommended antibiotic therapy.

The results demonstrated that only 56% of patients hospitalized with CAP at a major medical center in Arizona were tested for CM, as recommended by the CDC, and those diagnosed continued to receive antibacterials. These results affirm the importance of establishing a CAP continuous quality improvement program in the coccidioidal endemic region focused on CM testing and antimicrobial stewardship.

All Authors: No reported disclosures