Clinical question: Do patients need continued antibiotics after leaving the hospital?
Background: Despite inpatient antimicrobial stewardship programs, studies suggest that up to half of antibiotics prescribed at discharge could be improved. How antibiotic overuse varies across hospitals and patient conditions has yet to be assessed. Understanding and addressing variations in antibiotic overuse may improve prescribing patterns.
Study design: Retrospective cohort study
Setting: Michigan Hospital Medicine Safety Consortium that includes rural, community, and academic teaching hospitals
Synopsis: This study evaluated 12,445 patients treated for pneumonia and 9,380 treated for a urinary tract infection (UTI) (N=21,825) from 46 unique hospitals over a two-year period. The authors found that despite 41.5% of these patients failing to meet diagnostic criteria (12.9% for pneumonia and 28.6% for UTI), 72.4% were prescribed an antibiotic at discharge and 49.1% experienced antibiotic overuse based on the metrics of unnecessary use, excess duration of use, and suboptimal use of fluoroquinolones. There was a five-fold variation among hospitals of percentage of patients discharged with antibiotic overuse ranging from 15.9% (95% CI, 8.7-24.6) to 80.6% (95% CI: 69.4-88.1).
Bottom line: Antibiotic stewardship during care transitions can decrease antibiotic overuse at discharge.
Citation: Vaughn VM, et al. Antibiotic overuse after hospital discharge: a multi-hospital cohort study. Clin Infect Dis. 2021;73(11):e4499-e4506. doi: 10.1093/cid/ciaa1372.
Dr. Apodaca, @krystleapodaca, is a nurse practitioner hospitalist and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.