Medical short-stay units ‘overlooked’ as a source of antibiotic overuse
An assessment of 100 patients discharged from two medical short-stay units showed that 78% of their antibiotic prescriptions involved at least one type of antibiotic overuse, and 28% involved multiple types, researchers reported.
“At our institution and at many others, antibiotic prescribing at discharge from acute-care services has been increasingly recognized as a source of overuse and has been targeted by stewardship efforts,” Nathaniel S. Soper, MD, clinical instructor in the division of hospital medicine at the University of Michigan, told Healio. “We have seen significant improvements in discharge antibiotic prescribing with recent stewardship efforts at our institution. However, discharge antibiotic prescribing has not been evaluated for medical short-stay units.”
According to Soper, medical short-stay units have become increasingly prevalent at various institutions. Their unique environments introduce some additional potential barriers to appropriate antibiotic prescribing because of frequent handoffs combined with institutional pressures to ensure patients improve quickly and are ready for discharge, he said.
“We felt characterizing antibiotic prescribing at discharge from medical short-stay units was an important first step in developing targeted stewardship interventions,” Soper said.
To do so, Soper and colleagues performed as cross-sectional study of patients hospitalized in either of two medical short-stay units with a total of 40 beds. They included adults discharged with an oral antibiotic prescription between May 2018 and September 2019, identifying patients based on discharge diagnosis codes for common infections or abnormal urine cultures to identify UTIs.
Among 100 patients discharged from the short-stay units with antibiotics, 47 had a skin and soft tissue infection (SSTI), 22 had pneumonia, 21 had a UTI and 10 had other infections. According to the study, 78 cases (78%) involved antibiotic overuse, including 39 (83%) among the 47 patients treated for SSTI, 17 (81%) among the 21 patients treated for UTI, and 14 (64%) among the 22 patients treated for pneumonia. Additionally, 28 (28%) patients who were discharged had multiple types of antibiotic overuse.
The study demonstrated that the most common types of overuse were excess duration (54%) with the median excess duration being 3.5 days and guideline-discordant selection (44%). Factors influencing overuse included consultant recommendations, miscalculation of duration and the need for source control procedure, the researchers said.
“Medical short-stay units are an overlooked source of significant antibiotic overuse, and dedicated stewardship efforts are needed,” Soper said. “Such stewardship efforts will likely need to be tailored to the unique challenges of these units and will need cooperation with various consultant services.”