ID specialists improve adherence to antibiotic stewardship principles in hospitals
Patients in hospitals with an infectious disease specialist are treated with antibiotics in a manner more consistent with antibiotic stewardship principles, according to results published in Clinical Infectious Diseases.
“Our findings suggest that patients at hospitals with an ID specialist received fewer antibiotics than patients at hospitals without an ID specialist. These differences were noted even after we adjusted for key differences in the types of patients cared for across all sites,” Daniel Livorsi, MD, MSc, assistant professor of internal medicine and infectious diseases at the University of Iowa’s Carver College of Medicine, told Healio. “More specifically, patients at the ID hospitals received fewer broad-spectrum antibiotics and more narrow-spectrum antibiotics. Promoting narrow-spectrum over broad-spectrum antibiotic use is a common goal of stewardship programs.”
Livorsi and colleagues compared patient-level antibiotic exposure at 122 Veterans Health Administration (VHA) hospitals with and without on-site ID specialists, defined as ID pharmacists and ID physicians. They used a survey to identify hospitals’ antibiotic stewardship processes and access to on-site ID specialists. All acute-care patient admissions in 2016 were included. Antibiotic use was quantified as days of therapy per number of days present and categorized these admissions using National Healthcare Safety Network definitions.
In total, 18 of the 122 hospitals (14.8%) did not have an on-site ID specialist. There were 23,007 (4.2%) admissions at sites without an ID clinician and 525,451 (95.8%) admissions at ID hospitals. The presence of an ID specialist correlated with a lower total of inpatient antibacterial use (OR = 0.92; 95% CI, 0.85-0.99), lower use of broad-spectrum antibacterials (OR = 0.61; 95% CI, 0.54-0.7) and higher narrow-spectrum beta-lactam use (OR = 1.43; 95% CI, 1.22-1.67). Total antibacterial exposure decreased in patients at ID vs. non-ID hospitals (OR = 0.92; 95% CI, 0.86-0.99).
“We were unable to measure how much time the ID specialist devoted to stewardship activities,” Livorsi said. “Given the cross-sectional design, it was unclear whether the patterns of antibiotic use we observed reflected the influence of the ID specialist or unrelated factors, such as institutional norms.”
Livorsi also noted that the researchers were surprised by the number of ID physicians at VA hospitals.
“I was surprised that only a small proportion of VA hospitals lacked access to an on-site ID physician,” he said. “At the national level, a larger proportion of hospitals outside the VA lack an ID specialist.”