Patient Complexities Associated With Antibiotic Ordering
Clinical question: What is the influence of patient complexities on providers’ decisions to prescribe antibiotics in three common hospital-based clinical vignettes?
Background: Antibiotic treatment decisions for medically complex patients are complicated, because the risk of undertreatment may be severe, while overtreatment may be associated with adverse effects and the emergence of resistant pathogens. It is believed that physicians are more likely than not to prescribe antibiotics for complex patients.
Study design: Hospital-based, physician survey.
Setting: Three urban academic medical centers in Los Angeles County, Calif.
Synopsis: Physicians were presented with three clinical vignettes, with variations by age, comorbidity, functional status, and follow-up, and asked to choose the best antibiotic regimen. Of the 874 invited physicians, 255 (29%) responded to the survey; 245 physicians were eligible for the study.
Study results showed 28% to 49% of physicians recommended antibiotics that were inconsistent with national guidelines. This percentage increased to 48% to 63% for medically complex patients, defined as those with older age, high medical comorbidity burden, poor functional status, or limited follow-up after hospital discharge (P<0.01). Resident physicians (n=183) were more likely than attending physicians (n=57) to have recommended antibiotics in the baseline vignettes (43% vs. 34%, P<0.05) and in all four vignettes with patient complexities.
Bottom line: Inappropriate antibiotic use was prevalent and occurred more often for patients with medical complexities.
Citation: Wooten D, Kahn K, Grein JD, Eells SJ, Miller LG. The association of patient complexities with antibiotic ordering. J Hosp Med. 2015;10:1-7.