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Antibiotic Overuse After Hospital Discharge: A Multi-hospital Cohort Study
- Source :
- Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- Background Antibiotics are commonly prescribed to patients as they leave the hospital. We aimed to create a comprehensive metric to characterize antibiotic overuse after discharge among hospitalized patients treated for pneumonia or urinary tract infection (UTI), and to determine whether overuse varied across hospitals and conditions. Methods In a retrospective cohort study of hospitalized patients treated for pneumonia or UTI in 46 hospitals between 1 July 2017–30 July 2019, we quantified the proportion of patients discharged with antibiotic overuse, defined as unnecessary antibiotic use, excess antibiotic duration, or suboptimal fluoroquinolone use. Using linear regression, we assessed hospital-level associations between antibiotic overuse after discharge in patients treated for pneumonia versus a UTI. Results Of 21 825 patients treated for infection (12 445 with pneumonia; 9380 with a UTI), nearly half (49.1%) had antibiotic overuse after discharge (56.9% with pneumonia; 38.7% with a UTI). For pneumonia, 63.1% of overuse days after discharge were due to excess duration; for UTIs, 43.9% were due to treatment of asymptomatic bacteriuria. The percentage of patients discharged with antibiotic overuse varied 5-fold among hospitals (from 15.9% [95% confidence interval, 8.7%–24.6%] to 80.6% [95% confidence interval, 69.4%–88.1%]) and was strongly correlated between conditions (regression coefficient = 0.85; P < .001). Conclusions Antibiotic overuse after discharge was common and varied widely between hospitals. Antibiotic overuse after discharge was associated between conditions, suggesting that the prescribing culture, physician behavior, or organizational processes contribute to overprescribing at discharge. Multifaceted efforts focusing on all 3 types of overuse and multiple conditions should be considered to improve antibiotic prescribing at discharge.<br />Of 21 825 hospitalized patients with pneumonia or urinary tract infection in 46 hospitals, half (49.1%) had antibiotic overuse after discharge. Overuse varied 5-fold among hospitals (15.9%–80.6%) and was correlated between conditions. To improve prescribing, stewardship should include care transitions.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
medicine.drug_class
Urinary system
030106 microbiology
Antibiotics
antibiotic stewardship
Antibiotic prescribing
Cohort Studies
03 medical and health sciences
0302 clinical medicine
quality of care
Internal medicine
medicine
Hospital discharge
Humans
pneumonia
030212 general & internal medicine
Antibiotic use
Online Only Articles
Retrospective Studies
business.industry
transitions of care
Retrospective cohort study
medicine.disease
Hospitals
Patient Discharge
Anti-Bacterial Agents
Pneumonia
AcademicSubjects/MED00290
Infectious Diseases
Antimicrobial Resistance and Stewardship
Urinary Tract Infections
urinary tract infection
business
Cohort study
Subjects
Details
- ISSN :
- 15376591 and 10584838
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Clinical Infectious Diseases
- Accession number :
- edsair.doi.dedup.....9f785412e4e4f50703f0317dca7af8cf