title: Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach.
abstract: OBJECTIVE For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Postdischarge therapy is often unnecessarily broad spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations. DESIGN Single center, quasi-experimental retrospective cohort study METHODS Patients prescribed oral antibiotics at hospital discharge before (July 2012-June 2013) and after (October 2014-February 2015) an intervention consisting of (1) institutional guidance for oral step-down antibiotic selection and duration of therapy and (2) pharmacy audit of discharge prescriptions with real-time prescribing recommendations to providers. The primary outcomes measured were total prescribed duration of therapy and use of antibiotics with broad gram-negative activity (ie, fluoroquinolones or amoxicillin-clavulanate). RESULTS Overall, 300 cases from the preintervention period and 200 cases from the intervention period were included. Compared with the preintervention period, the use of antibiotics with broad gram-negative activity decreased during the intervention (51% vs 40%; P=.02), particularly fluoroquinolones (38% vs 25%; P=.002). The total duration of therapy decreased from a median of 10 days (interquartile range [IQR], 7-13 days) to 9 days (IQR, 6-13 days) but did not reach statistical significance (P=.13). However, the duration prescribed at discharge declined from 6 days (IQR, 4-10 days) to 5 days (IQR, 3-7 days) (P=.003). During the intervention, there was a nonsignificant increase in the overall appropriateness of discharge prescriptions from 52% to 66% (P=.15). CONCLUSIONS A multifaceted intervention to optimize antibiotic prescribing at hospital discharge was associated with less frequent use of antibiotics with broad gram-negative activity and shorter postdischarge treatment durations. Infect Control Hosp Epidemiol 2017;38:534-541.
authors.affiliation: 1Sharp Rees-Stealy Medical Group,San Diego,California.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Yogo
authors.affiliation: 4Denver Health,Denver,Colorado.
authors.forename: Katherine
authors.initials: K
authors.lastname: Shihadeh
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,University of Colorado,Aurora,Colorado.
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.affiliation: 4Denver Health,Denver,Colorado.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Calcaterra
authors.affiliation: 4Denver Health,Denver,Colorado.
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,University of Colorado,Aurora,Colorado.
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
authors.affiliation: 3University of Colorado School of Medicine,Aurora,Colorado.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mehler
authors.affiliation: 2Division of Infectious Diseases,Department of Medicine,University of Colorado,Aurora,Colorado.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003120:Colorado; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008485:Medical Audit; D008499:Medical Records; D010351:Patient Discharge; D010595:Pharmacists; D015397:Program Evaluation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents