Clin Infect Dis. 2021 Sep 23:ciab842. doi: 10.1093/cid/ciab842. Online ahead of print.
Though opportunities exist to improve antibiotic prescribing across the care spectrum, discharge from acute hospitalization is an increasingly recognized source of antibiotic overuse. Antimicrobials are prescribed to more than one in eight patients at hospital discharge; approximately half of which could be improved. Key targets for antibiotic stewardship at discharge include unnecessary antibiotics, excess duration, avoidable fluoroquinolones, and improving (or avoiding) intravenous antibiotic therapy. Barriers to discharge antibiotic stewardship include the perceived "high stakes" of care transitions during which patients move from intense to infrequent observation, difficulties in antibiotic measurement to guide improvement at discharge, and poor communication across silos-particularly with skilled nursing facilities. In this review, we discuss what is currently known about antibiotic overuse at hospital discharge, key barriers and targets for improving antibiotic prescribing at discharge, and introduce an evidence-based framework, the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework, for conducting discharge antibiotic stewardship.