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Antibiotic stewardship needed at transition of care
Nearly three quarters of systemic antibiotics prescribed to a random sample of patients upon hospital discharge were inappropriate, according to data from a retrospective study.
“Until now, antibiotic stewardship has focused mostly on inpatient care. However, medication errors are especially likely during transitions of care,” Sarah J. Scarpato, MD, of the department of internal medicine at the Hospital of the University of Pennsylvania, Philadelphia, and colleagues wrote. “Despite successes of inpatient antimicrobial stewardship programs, antimicrobial stewardship is often neglected during transitions of care, and to our knowledge no published studies have evaluated the appropriateness of antibiotics prescribed at patient discharge.”
The researchers reviewed 9,750 systemic antibiotic prescriptions written for 7,313 patients discharged from the Hospital of the University of Pennsylvania during 2014. They obtained data on inpatient service; patients’ medications, creatinine levels and weight at discharge; and readmission status 7 and 30 days post-discharge. Researchers also took a random sample of 150 patients’ medical charts to review microbiology and imaging results, as well as antibiotic regimens and indications.
Fluoroquinolones were the most common antibiotics prescribed, Scarpato and colleagues reported, comprising 23.5% of all antibiotic prescriptions. Eighty-six percent of prescriptions were oral antibiotics, and 14% were parenteral. The 7-day readmission rate for all patients discharged on antibiotics was 6.4%, while 30-day readmission was 19.4%, compared with a hospital-wide rate of 3.7% at 7 days and 13.8% at 30 days. Patients on oral antibiotics had readmission rates of 6.5% and 19.9%, compared with rates of 5.6% and 16.4% among patients on parenteral or intramuscular antibiotics.
Among the 150 medical charts sampled, Scarpato and colleagues wrote that 70% of antibiotics prescribed at discharge were inappropriate in duration, drug choice or dose. Thirteen percent of patients with a documented infection received medication that was either too broad or too narrow, while 17% received the wrong dose, the researchers wrote. More than half (55%) were prescribed antibiotics for too long, and 7.3% were on too short a course. Patients received an average 3.8 days of unnecessary antibiotics. Most surgical patients (87.7%) and more than half of medical patients (57.6%) were prescribed inappropriate medications.
The researchers acknowledged that the study was limited as it was a retrospective study, and was carried out at a teaching hospital where many residents were prescribing medications.
“However, the findings suggest that there is a significant and unmet need for antimicrobial stewardship at transitions of care, even at institutions like ours with substantial antimicrobial stewardship programs,” Scarpato and colleagues wrote. “Future efforts should focus on reducing inappropriate antibiotic prescriptions, specifically decreasing prescriptions without an acceptable indication and those with inappropriate duration.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.