An Evaluation of Antibiotic Prescribing Practices Upon Hospital Discharge

Scarpato, Sarah; Timko, Daniel; Cluzet, Valerie; Dougherty, Jillian; Nunez, Jonathan; Hamilton, Keith

doi:10.1093/ofid/ofw194.12

Cited by 16 publications

(32 citation statements)

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“…Frequency of discharge prescribing by agent and drug class revealed that 25% of all discharge antimicrobial prescriptions were fluoroquinolones. Our data are consistent with those of Scarpato et al, 15 who noted a similar fluoroquinolone prescribing rate of 23.5% when evaluating discharge prescriptions from the Hospital of the University of Pennsylvania. Our fluoroquinolone prescribing rate was lower than the 40% rate described by Yogo et al 8 for discharge prescriptions filled within 7 days posthospitalization, lower than the 47%-49% rate of outpatient prescribing noted in a study of community acquired pneumonia by Yi et al, 24 and lower than the 30.5% rate cited by Vaughn et al 25 from patients diagnosed with urinary tract infection or community-acquired pneumonia in 48 hospitals in the Michigan Hospital Medicine Safety Consortium.…”

Section: Discussionsupporting

confidence: 92%

“…Previous investigation of discharge prescriptions has indicated that when discharge durations are factored into prescribing, 55% of patients receive a course of antibiotics that is too long and, on average, patients receive 3.8 days of unnecessary antibiotic therapy. 15 For many common infections, short-course therapy is equivalent to longer durations of therapy. 4 In controlled clinical trials, uncomplicated community acquired pneumonia can be treated in as few as 5 days; hospital-acquired or ventilator-associated pneumonia, ≤7-8 days; pyelonephritis, 5-7 days; cellulitis, 5 days; and intra-abdominal infection, 4-7 days.…”

Section: Discussionmentioning

confidence: 99%

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Total duration of antimicrobial therapy resulting from inpatient hospitalization

Dyer

Ashley

Anderson

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:To assess the feasibility of electronic data capture of postdischarge durations and evaluate total durations of antimicrobial exposure related to inpatient hospital stays.Design:Multicenter, retrospective cohort study.Setting:Two community hospitals and 1 academic medical center.Patients:Hospitalized patients who received ≥1 dose of a systemic antimicrobial agent.Methods:We collected and reviewed electronic data on inpatient and discharge antimicrobial prescribing from April to September 2016 in 3 pilot hospitals. Inpatient antimicrobial use was obtained from electronic medication administration records. Postdischarge antimicrobial use was calculated from electronic discharge prescriptions. We completed a manual validation to evaluate the ability of electronic prescriptions to capture intended postdischarge antibiotics. Inpatient, postdischarge, and total lengths of therapy (LOT) per admission were calculated to assess durations of antimicrobial therapy attributed to hospitalization.Results:A total of 45,693 inpatient admissions were evaluated. Antimicrobials were given during 23,447 admissions (51%), and electronic discharge prescriptions were captured in 7,442 admissions (16%). Manual validation revealed incomplete data capture in scenarios in which prescribers avoided the electronic system. The postdischarge LOT among admissions with discharge antimicrobials was median 8 days (range, 1–360) with peaks at 5, 7, 10, and 14 days. Postdischarge days accounted for 38% of antimicrobial exposure days.Conclusion:Discharge antimicrobial therapy accounted for a large portion of antimicrobial exposure related to inpatient hospital stays. Discharge prescription data can feasibly be captured through electronic prescribing records and may aid in designing stewardship interventions at transitions of care.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Total duration of antimicrobial therapy resulting from inpatient hospitalization

Dyer

Ashley

Anderson

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…Based on these results, they recommended medication reconciliation by trained pharmacists, prescriber education, and prospective audit and feedback to improve prescribing practices. 24 Furthermore, a recent systematic review concluded that medication reconciliation upon discharge is unlikely to reduce postdischarge healthcare utilization in the absence of other transitions of care intervention components. 25 We did not observe a significant association between receiving an antibiotic prescription upon discharge and 30-day hospital readmissions, which would have provided a financial incentive for acute-care hospitals to improve antibiotic prescribing in this patient population.…”

Section: Discussionmentioning

confidence: 99%

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

Weber

Noble

Bearden

et al. 2018

Infect. Control Hosp. Epidemiol.

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ObjectiveTo quantify the frequency and outcomes of receiving an antibiotic prescription upon discharge from the hospital to long-term care facilities (LTCFs).DesignRetrospective cohort study.SettingA 576-bed, academic hospital in Portland, Oregon.PatientsAdult inpatients (≥18 years of age) discharged to an LTCF between January 1, 2012, and June 30, 2016.MethodsOur 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.ResultsAmong 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).ConclusionsAntibiotics were frequently prescribed upon discharge to LTCFs, which may be associated with increased risk of poor outcomes post discharge.

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“…Their study highlights an important opportunity to improve antibiotic prescribing at the time of hospital discharge. Antibiotics are commonly prescribed when patients are discharged from the hospital [2], and are frequently prescribed inappropriately [3][4][5]. One analysis found that most antibiotic prescriptions at discharge were oral (86.0%), and fluoroquinolones were the most common antibiotic class prescribed (23.5%) [5].…”

Section: Reply To Mercuro Et Almentioning

confidence: 99%

“…One of the most common causes of inappropriate prescribing at discharge is an unnecessarily prolonged duration of the treatment course. In a study by Scarpato et al [5], 55% of inappropriate prescriptions on discharge were due to prolonged duration, with patients receiving an average of 3.8 days of unnecessary antibiotics. Another review found that 33% of inappropriate prescriptions were due to excessive duration, and approximately 65% of total antibiotic treatment duration was completed after hospital discharge [4].…”

Section: Reply To Mercuro Et Almentioning

confidence: 99%