Clin Infect Dis. 2020 Sep 11:ciaa1372. doi: 10.1093/cid/ciaa1372. Online ahead of print.
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 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 7/1/2017-7/30/2019 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 association between antibiotic overuse after discharge in patients treated for pneumonia vs. UTI.
RESULTS: Of 21,825 patients treated for infection (12,445 pneumonia; 9,380 UTI), nearly half (49.1%) had antibiotic overuse after discharge (56.9% pneumonia; 38.7% UTI). For pneumonia, 63.1% of overuse days after discharge were due to excess duration; for UTI, 43.9% were due to treatment of asymptomatic bacteriuria. The percentage of patients discharged with antibiotic overuse varied five-fold among hospitals (15.9% [95% CI: 8.7%-24.6%] to 80.6% [95% CI:69.4%-88.1%]) and was strongly correlated between conditions (regression coefficient=0.85, P&.001).
CONCLUSION: Antibiotic overuse after discharge was common and varied widely between hospitals. Antibiotic overuse after discharge was associated between conditions, suggesting that prescribing culture, physician behavior, or organizational processes contribute to overprescribing at discharge. Multifaceted efforts focusing on all three types of overuse and multiple conditions should be considered to improve antibiotic prescribing at discharge.