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Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings

Published online by Cambridge University Press:  09 November 2018

Bo R. Weber ,
Brie N. Noble ,
David T. Bearden ,
Christopher J. Crnich ,
Katherine D. Ellingson ,
Jessina C. McGregor  and
Jon P. Furuno
Bo R. Weber
Affiliation:
Department of Pharmacy Practice, Oregon State University, Oregon Health & Science University College of Pharmacy, Portland, Oregon Department of Pharmacy Services, Oregon Health & Science University Hospitals and Clinics, Portland, Oregon
Brie N. Noble
Affiliation:
Department of Pharmacy Practice, Oregon State University, Oregon Health & Science University College of Pharmacy, Portland, Oregon
David T. Bearden
Affiliation:
Department of Pharmacy Practice, Oregon State University, Oregon Health & Science University College of Pharmacy, Portland, Oregon Department of Pharmacy Services, Oregon Health & Science University Hospitals and Clinics, Portland, Oregon
Christopher J. Crnich
Affiliation:
Medical Service, William S. Middleton Veterans Hospital, Madison, Wisconson Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Katherine D. Ellingson
Affiliation:
Department of Epidemiology and Biostatistics, The University of Arizona College of Public Health, Tucson, Arizona
Jessina C. McGregor
Affiliation:
Department of Pharmacy Practice, Oregon State University, Oregon Health & Science University College of Pharmacy, Portland, Oregon
Jon P. Furuno*
Affiliation:
Department of Pharmacy Practice, Oregon State University, Oregon Health & Science University College of Pharmacy, Portland, Oregon
*
Author for correspondence: Jon P. Furuno, Oregon State University, Oregon Health & Science University College of Pharmacy, Department of Pharmacy Practice, 2730 SW Moody Ave, Mail Code: CL5CP, Portland, OR 97201. E-mail: furuno@ohsu.edu
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Abstract

Objective

To quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).

Design

Retrospective cohort study.

Setting

A 576-bed, academic hospital in Portland, Oregon.

Patients

Adult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.

Methods

Our primary outcome was receiving a systemic antibiotic prescription upon discharge to an LTCF. We also quantified the association between receiving an antibiotic prescription and 30-day hospital readmission, 30-day emergency department (ED) visit, and Clostridium difficile infection (CDI) on a readmission or ED visit at the index facility within 60 days of discharge.

Results

Among 6,701 discharges to an LTCF, 22.9% were prescribed antibiotics upon discharge. The most prevalent antibiotic classes prescribed were cephalosporins (20.4%), fluoroquinolones (19.1%), and penicillins (16.7%). The medical records of ~82% of patients included a diagnosis code for a bacterial infection on the index admission. Among patients prescribed an antibiotic upon discharge, the incidence of 30-day hospital readmission to the index facility was 15.9%, the incidence of 30-day ED visit at the index facility was 11.0%, and the incidence of CDI on a readmission or ED visit within 60 days of discharge was 1.6%. Receiving an antibiotic prescription upon discharge was significantly associated with 30-day ED visits (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.02–1.5) and with CDI within 60 days (aOR, 1.7; 95% CI, 1.02–2.8) but not with 30-day readmissions (aOR, 1.01; 95% CI, 0.9–1.2).

Conclusions

Antibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 1 , January 2019 , pp. 18 - 23
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: These data were presented in part at the 2016 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exposition on December 6, 2016, in Las Vegas, Nevada, and at the 2017 American Society of Health-System Pharmacists Midyear Clinical Meeting and Exposition on December 5, 2017, in Orlando, Florida.

Cite this article: Weber Bo R. (2019). Antibiotic prescribing upon discharge from the hospital to long-term care facilities: Implications for antimicrobial stewardship requirements in post-acute settings. Infection Control & Hospital Epidemiology 2019, 40, 18–23. doi: 10.1017/ice.2018.288

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