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Intervention to Reduce Broad-Spectrum Antibiotics and Treatment Durations Prescribed at the Time of Hospital Discharge: A Novel Stewardship Approach

Published online by Cambridge University Press:  06 March 2017

Norihiro Yogo ,
Katherine Shihadeh ,
Heather Young ,
Susan L. Calcaterra ,
Bryan C. Knepper ,
William J. Burman ,
Philip S. Mehler  and
Timothy C. Jenkins
Norihiro Yogo*
Affiliation:
Sharp Rees-Stealy Medical Group, San Diego, California Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado University of Colorado School of Medicine, Aurora, Colorado
Katherine Shihadeh
Affiliation:
Denver Health, Denver, Colorado
Heather Young
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado University of Colorado School of Medicine, Aurora, Colorado Denver Health, Denver, Colorado Department of Patient Safety and Quality, Denver Health, Denver, Colorado
Susan L. Calcaterra
Affiliation:
Denver Health, Denver, Colorado Department of Medicine, University of Colorado, Aurora, Colorado
Bryan C. Knepper
Affiliation:
Denver Health, Denver, Colorado Department of Patient Safety and Quality, Denver Health, Denver, Colorado
William J. Burman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado University of Colorado School of Medicine, Aurora, Colorado Denver Health, Denver, Colorado
Philip S. Mehler
Affiliation:
University of Colorado School of Medicine, Aurora, Colorado Denver Health, Denver, Colorado
Timothy C. Jenkins
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, Colorado University of Colorado School of Medicine, Aurora, Colorado Denver Health, Denver, Colorado Department of Patient Safety and Quality, Denver Health, Denver, Colorado
*
Address correspondence to Norihiro Yogo; 2020 Genesee Ave, San Diego, CA 92123 (Norihiro.Yogo@sharp.com).
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Abstract

OBJECTIVE

For most common infections requiring hospitalization, antibiotic treatment is completed after hospital discharge. Postdischarge therapy is often unnecessarily broad spectrum and prolonged. We developed an intervention to improve antibiotic selection and shorten treatment durations.

DESIGN

Single center, quasi-experimental retrospective cohort study

METHODS

Patients prescribed oral antibiotics at hospital discharge before (July 2012–June 2013) and after (October 2014–February 2015) an intervention consisting of (1) institutional guidance for oral step-down antibiotic selection and duration of therapy and (2) pharmacy audit of discharge prescriptions with real-time prescribing recommendations to providers. The primary outcomes measured were total prescribed duration of therapy and use of antibiotics with broad gram-negative activity (ie, fluoroquinolones or amoxicillin-clavulanate).

RESULTS

Overall, 300 cases from the preintervention period and 200 cases from the intervention period were included. Compared with the preintervention period, the use of antibiotics with broad gram-negative activity decreased during the intervention (51% vs 40%; P=.02), particularly fluoroquinolones (38% vs 25%; P=.002). The total duration of therapy decreased from a median of 10 days (interquartile range [IQR], 7–13 days) to 9 days (IQR, 6–13 days) but did not reach statistical significance (P=.13). However, the duration prescribed at discharge declined from 6 days (IQR, 4–10 days) to 5 days (IQR, 3–7 days) (P=.003). During the intervention, there was a nonsignificant increase in the overall appropriateness of discharge prescriptions from 52% to 66% (P=.15).

CONCLUSIONS

A multifaceted intervention to optimize antibiotic prescribing at hospital discharge was associated with less frequent use of antibiotics with broad gram-negative activity and shorter postdischarge treatment durations.

Infect Control Hosp Epidemiol 2017;38:534–541

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 5 , May 2017 , pp. 534 - 541
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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