Antibiotic Prescribing at the Transition from Hospitalization to Discharge: A Target for Antibiotic Stewardship

Yogo, Norihiro; Haas, Michelle; Knepper, Bryan; Burman, William J.; Mehler, Philip S.; Jenkins, Timothy C

doi:10.1017/ice.2014.85

Cited by 47 publications

(71 citation statements)

References 10 publications

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“…Although our study population was small, the percentage of appropriate therapy at baseline was similar to that seen reported in previous studies of discharge anti-infective prescribing. 5 Readmissions seen at 30 days decreased, albeit not significant. A larger sample size would be necessary to determine a significant difference.…”

Section: Discussionmentioning

confidence: 93%

Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Zampino

Politis

Fosnight

et al. 2020

Infect. Control Hosp. Epidemiol.

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Antimicrobial stewardship of anti-infectives prescribed upon hospital discharge was implemented to improve the rate of appropriate prescribing at discharge. Appropriate prescribing significantly improved from 47.5% to 85.2% (P < .001), antimicrobial days of therapy decreased, and 30-day readmission rates decreased. Discharge antimicrobial stewardship was effective in improving anti-infective prescribing practices.

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Section: Discussionmentioning

confidence: 93%

Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Zampino

Politis

Fosnight

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…A number of previous studies have demonstrated that for infections commonly managed in the hospital, 60–70% of the total antibiotic course is completed after discharge [4–8]. Thus, ensuring appropriate antibiotic selection at discharge represents an important opportunity to reduce use of antibiotics with overly broad-spectrum activity.…”

Section: Discussionmentioning

confidence: 99%

“…Third, there was a relatively long gap between the pre-intervention period and the start of the intervention. This is because the intervention itself was designed and implemented after collection of and in response to the pre-intervention period data [8]. We are not aware of any factors that would have impacted hospital discharge prescribing practices during this time.…”

Section: Discussionmentioning

confidence: 99%

“…The pre-intervention cohort was a previously published cohort discharged between1 July 2012 and 30 June 2013 [8]. The intervention cohort included patients discharged between 1 October 2014 and 28 February 2015.…”

Section: Methodsmentioning

confidence: 99%

“…The Infectious Diseases Society of America, Society for Hospital Epidemiology of America, and Centers for Disease Control and Prevention (CDC) provide recommendations for implementing antibiotic stewardship interventions in hospitals [2, 3]. Most of these interventions are geared toward improving antibiotic use during the hospitalization itself; however, a number of studies have demonstrated that for common infections, approximately two-thirds of the total treatment course is completed after the patient is discharged [4–8]. In addition, antibiotics dispensed at the time of hospital discharge are frequently suboptimal due to an overly broad spectrum of activity or excessive duration [8].…”

Section: Introductionmentioning

confidence: 99%

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Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Yogo

Shihadeh

Young

et al. 2017

Infect. Control Hosp. Epidemiol.

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Objective For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Post-discharge 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 were total prescribed duration of therapy and use of antibiotics with broad gram-negative activity (fluoroquinolones or amoxicillin-clavulanate). Results 300 cases from the pre-intervention period and 200 from the intervention period were included. Compared with the pre-intervention period, use of antibiotics with broad gramnegative activity decreased during the intervention (51% vs 40%, p = 0.02), particularly fluoroquinolones (38% vs 25%, p = 0.002). The difference in total duration of therapy did not reach statistical significance (10 days [interquartile range (IQR) 7–13] vs 9 [IQR 6–13], p = 0.13); however, the duration prescribed at discharge declined from 6 days (IQR 4–10) to 5 (IQR 3–7) (p = 0.003). During the intervention, there was a non-significant increase in the overall appropriateness of discharge prescriptions (52% vs 66%, p = 0.15). 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 post-hospital treatment durations.

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Treatment of asymptomatic pyuria in psychiatric patients discharged from the emergency department following antimicrobial stewardship implementation

Ellena

Wolf

Dumkow

et al. 2020

J Am Coll Clin Pharm

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Introduction Abnormal urinalysis (UA) results, such as pyuria or bacteriuria, increase the risk for antibiotic treatment even in the absence of urinary symptoms. In the emergency department (ED), patients presenting with psychiatric emergencies commonly undergo a medical assessment which includes a UA. We hypothesized that the rate of inappropriate antibiotic treatment for asymptomatic pyuria in the psychiatric medical population would decrease following implementation of an antimicrobial stewardship program (ASP) in the ED. Methods This retrospective cohort study compared the treatment of adult patients presenting to the ED for medical assessment during a psychiatric emergency with noted pyuria between three time periods following implementation of an ASP: early ASP (2014), established ASP (2016), and mature ASP (2018). The ASP provided education and routine audit‐and‐feedback focused on reducing urine testing and eliminating treatment of asymptomatic pyuria. The primary end point was to compare rates of inappropriate treatment of asymptomatic pyuria between groups. Secondary end points included comparing appropriate agent selection and duration for patients who were prescribed antibiotics, prescriber documentation, and patient outcomes between groups. Results A total of 180 patients with pyuria were included; 60 within each study group with 88.3% being asymptomatic. Inappropriate prescribing of antibiotics for asymptomatic patients at ED discharge decreased over time following ASP implementation (2014 = 40.4%, 2016 = 31.4%, 2018 = 17.6%; P = .036). Additionally, documentation noting a positive UA requiring antibiotic treatment decreased (2014 = 46.7%, 2016 = 40%, 2018 = 26.7%). Of the 62 patients treated with antibiotics, selection of a first‐line agent increased with ASP maturity (2014 = 15.4%, 2016 = 26.1%, 2018 = 69.9%; P = .002). Conclusion Inappropriate treatment of asymptomatic pyuria in patients presenting to the ED with psychiatric emergencies decreased significantly over time following implementation of an ASP. EDs may benefit from ASP interventions aimed at decreasing reliance on UA interpretation in this patient population.

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Antibiotic Prescribing at the Transition from Hospitalization to Discharge: A Target for Antibiotic Stewardship

Cited by 47 publications

References 10 publications

Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Impact of the expansion of antimicrobial stewardship services during transitions of care at an academic hospital

Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Treatment of asymptomatic pyuria in psychiatric patients discharged from the emergency department following antimicrobial stewardship implementation

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