Methods: We conducted a descriptive study of patients prescribed an antimicrobial at discharge from an academic quaternary care hospital from January 1, 2014, through December 31, 2014. We retrospectively examined the appropriateness of antimicrobial agents prescribed on discharge for a randomly selected sample of 150 patients.
Results: During the study period, 9750 antibiotic prescriptions were written for patients upon hospital discharge with 86% for oral antibiotics and 14% for outpatient parenteral antibiotic therapy (OPAT). 7-day and 30-day readmission rates for patients discharged on antibiotics were 6.4% and 19.4%, respectively, compared to hospital-wide readmission rates of 3.70% and 13.79%. Patients discharged on OPAT had 7-day and 30-day readmission rates of 5.6% and 16.4%, while patients discharged on oral antibiotics had rates of 6.5% and 19.9%. Of patients discharged on antibiotics, 22% had no clinical indication of infection, 13% had an antibiotic with inappropriate spectrum of activity, 17% received the incorrect dose, 55% received an antibiotic course that was too long, and 7.3% received a course that was too short. The mean duration of unnecessary antibiotics was 3.8 days (range: 18 days too few to 36 days too many).
Conclusion: Despite a robust inpatient antibiotic stewardship program (ASP), most antibiotics prescribed on discharge were inappropriate. Antibiotic prescription in the absence of an acceptable indication and inappropriate duration accounted for 76% of inappropriate prescriptions. Our findings suggest that there is a significant and unmet need for antimicrobial stewardship at transitions in care, even at institutions with substantial inpatient ASPs.
V. Cluzet, None
J. Dougherty, None
J. Nunez, None
K. Hamilton, None