Currently, there is minimal literature detailing the utility or approach to antibiotic stewardship interventions at the transition of care. We sought to evaluate the utility of a stewardship approach where appropriateness of choice and duration of oral antibiotics prescribed at time of discharge was assessed and, when indicated, recommendations for change provided.
Between June 2017 and April 2018, an antimicrobial stewardship team, comprising of a pharmacist and infectious disease provider, reviewed the electronic health record (EHR) of patients discharged on oral antibiotics from the Medical Service at the William S Middleton VA Hospital for appropriateness of antibiotic choice and total duration of therapy. Depending on availability of team members, reviews occurred twice weekly and included patients discharged within the previous 4 days. If an antibiotic was felt to be inappropriate, the case was discussed with the prescribing service and/or pharmacist. Recommendations were documented in the form of a note placed in the EHR with an emphasis on education. These interventions were logged and information regarding prescribing team/provider, antibiotic, indication, and type of intervention was collected. Intervention types included (but were not limited to) antibiotic stop, change of antibiotic, dose, or duration, and lab recommendations.
Stewardship rounds evaluated 463 patients discharged on oral antibiotics from the Medical Service over 177 hospital days. Forty-one interventions were logged in 38 (8.2%) patients, i.e. approximately 1 intervention for every 12 patients discharged on oral antibiotics. The most common intervention type was antibiotic stop (49%), followed by change in duration (15%). Interventions occurred most commonly in patients treated for COPD (27%), UTI (22%), and pneumonia (15%). Azithromycin (27%), cefpodoxime (12%), and trimethoprim-sulfamethoxazole (12%) were the antibiotics most frequently intervened upon.
Assessing post-discharge antibiotic therapy with feedback to prescribers is an additional area where Stewardship programs can focus to better optimize usage of antimicrobials.
M. Peters, None
C. Crnich, None
S. Barnett, None
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