Antibiotic Prescribing at the Time of Hospital Discharge: a Target for Antibiotic Stewardship
For common infections requiring hospitalization, the majority of antibiotic treatment occurs after hospital discharge; however, prescribing practices at the transition to outpatient care have not been well described. The objectives of this study were to describe antibiotic use and evaluate appropriateness of oral antibiotics prescribed at the time of hospital discharge.
We identified a retrospective cohort of adult inpatients who were prescribed an oral antibiotic at the time of discharge between 1 July 2012 and 30 June 2013 at an academic medical center. Two Infectious Diseases specialists independently assessed the appropriateness of antibiotic(s) prescribed from a random sample of cases. We performed a multivariate logistic regression to identify factors associated with inappropriate prescriptions.
In total, 1825 unique patients were prescribed antibiotics; of these, 376 cases were randomly selected for manual review to reach 300 included cases. Antibiotics were most commonly prescribed for urinary tract infections (UTI) (n=72, 24%), community acquired pneumonia (CAP) (n=52, 17%), cellulitis and/or cutaneous abscess (n=48, 16%), and chronic obstructive pulmonary disease (COPD) exacerbations (n=23, 8%). The most commonly prescribed antibiotics were levofloxacin (n=115, 38%), azithromycin (n=37, 12%), and amoxicillin/clavulanate (n=37, 12%). Median total treatment duration was 10 days (interquartile range [IQR] 7-13) with a median duration after discharge of 6 days (IQR 4-10). Of the 150 cases randomly selected for appropriateness review, the discharge prescriptions in 115 cases (77%) were independently agreed upon as being appropriate (n=51, 44%) or inappropriate (n=64, 56%). The most common types of inappropriate use were excessive treatment duration (n=37, 58%) and antibiotic selection (n=20, 31%). Multivariate logistic regression analysis did not reveal any significant factors associated with inappropriate prescribing.
UTI, CAP, skin and soft tissue infections, and COPD exacerbations accounted for nearly two-thirds of conditions for which antibiotics were prescribed at hospital discharge. Discharge prescriptions were inappropriate in approximately half of cases suggesting a key target for antimicrobial stewardship.
B. Knepper, None
W. Burman, None
P. Mehler, None
T. Jenkins, None