Investigation of factors influencing inpatient antibiotic prescribing decisions in the Veterans’ Health Administration

Economos, Evan T; Goedken, Cassie Cunningham; Sherlock, Stacey Hockett; Suda, Katie J.; Goetz, Matthew Bidwell; Balkenende, Erin; Chasco, Emily E; Scherer, Aaron M.; Goto, Michihiko; Perencevich, Eli N; Reisinger, Heather Schacht; Livorsi, Daniel J

doi:10.1017/ash.2022.230

ASHE

2022

DOI: 10.1017/ash.2022.230

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Investigation of factors influencing inpatient antibiotic prescribing decisions in the Veterans’ Health Administration

Evan T Economos¹,

Cassie Cunningham Goedken

Stacey Hockett Sherlock

et al.

Abstract: To investigate factors that influence antibiotic prescribing decisions, we interviewed 49 antibiotic stewardship champions and stakeholders across 15 hospitals. We conducted thematic analysis and subcoding of decisional factors. We identified 31 factors that influence antibiotic prescribing decisions. These factors may help stewardship programs identify educational targets and design more effective interventions.

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“…One of every 2 hospitalized patients will receive an antibiotic [ 1 ]. Decision-making about how and when to prescribe antibiotics to hospitalized patients can be challenging [ 2 ]. Given the public health crisis of antibiotic resistance, there is a need to improve antibiotic prescribing, and tools that can aid in the optimization of antibiotic use are needed.…”

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Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score–Matched Cohort Across the Veterans Health Administration

Heren,

Lund,

Alexander

et al. 2023

Open Forum Infectious Diseases

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Background Randomized-controlled trials have shown that procalcitonin-guided algorithms can reduce antibiotic duration for lower respiratory tract infections (LRTIs). The goal of this study was to compare antibiotic duration for LRTIs with and without procalcitonin testing in real-life practice. Methods This retrospective cohort study included all acute-care hospital admissions for presumed LRTIs between 1/2018-12/2021 at 81 Veterans Affairs facilities with on-site procalcitonin testing. The exposure was procalcitonin testing; the primary outcome was antibiotic duration. We used 1:1 nearest-neighbor propensity score matching to estimate the difference in outcome between procalcitonin-tested and non-tested patients. Results 35,610 patients with LRTIs were included (6,015 [16.9%] with procalcitonin testing; 29,595 [83.1%] without testing). In tested patients, the median number of procalcitonin levels checked was 2 (interquartile range, 1-3). Mean antibiotic duration was 10.0 days in the procalcitonin group compared to 8.3 days in non-tested patients (unadjusted difference 1.7 days; p < 0.0001). After propensity-score matching with 3,903 pairs, antibiotic duration remained greater in the procalcitonin group (9.6 days vs. 9.2 days; p < 0.0001). In a sub-group analysis of 2,241 tested-patients with a procalcitonin value at the standard threshold for antibiotic discontinuation, antibiotic duration was shorter in tested vs. non-tested patients with a mean difference of 0.1 days (p<0.01). Conclusions In this retrospective propensity-matched cohort of patients with presumed LRTIs across a geographically-diverse group of hospitals, patients who underwent procalcitonin testing did not have a meaningful reduction in antibiotic duration compared to those who were not tested. Poor implementation of procalcitonin testing may have undermined its effectiveness.

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confidence: 99%

Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score–Matched Cohort Across the Veterans Health Administration

Heren,

Lund,

Alexander

et al. 2023

Open Forum Infectious Diseases

Self Cite

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Investigation of factors influencing inpatient antibiotic prescribing decisions in the Veterans’ Health Administration

Cited by 1 publication

References 10 publications

Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score–Matched Cohort Across the Veterans Health Administration

Procalcitonin Monitoring and Antibiotic Duration in Presumed Lower Respiratory Tract Infections: A Propensity Score–Matched Cohort Across the Veterans Health Administration

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