Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

Abstract

ObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.ResultsAmong 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

Factors associated with inappropriate intravenous antibiotic prescription in patients discharged from the emergency department

“…However, we have considered only adequacy with respect to the subsequent microbiological culture, and this is a limitation. In contrast, our patients showed >25% of reconsultations, which is higher than the results obtained in previous studies 11 . This phenomenon can be attributed to a more complex and old population.…”

Opioid prescribing on discharge to skilled nursing facilities

“…Study data were collected from a longitudinal repository of patients' electronic health record data maintained in partnership with the Oregon Clinical and Translational Institute (OCTRI) Research Data Warehouse. These data have been extensively validated in several previous epidemiologic studies of medication prescribing during transitions of care 12‐15 …”

“…The study design and methods of cohort identification have been previously described. 12 Briefly, this was a retrospective cohort study of adult (≥18 years) inpatients discharged from Oregon Health & Science University (OHSU) Hospital to a SNF between January 1, 2017 and December 31, 2018. During the study period, OHSU Hospital was a 576-bed academic, quaternary-care facility in Portland, Oregon.…”

Several Roads Lead to Rome: Operationalizing Antibiotic Stewardship Programs in Nursing Homes

“…Infections often present with atypical symptoms, such as fatigue, confusion, and functional decline . Furthermore, there is a burgeoning population of short‐stay residents in nursing homes receiving post–acute care who often present with higher severity of illness, prevalence of antibiotic use both in the hospital and on discharge, and indwelling devices, increasing the risk of acquisition and infection by multi–drug‐resistant organisms . Beyond challenges in resident characteristics and presentation of infection, there are additional barriers to optimizing antibiotic use in nursing homes, including the frequently fragmented administrative structure in this setting, lack of tools to support empiric antibiotic prescribing, and lack of education regarding guidelines and current evidence to support best practices.…”